| Objective: Patients undergoing off-pump coronary artery bypass grafting(OPCABG)usually need to send ICU for short-term monitoring.However,if this kind of patients stay in ICU for too long,it is often suggested that the operation has not achieved the desired results,or that there are complications related to the operation.This study reviewed and analyzed the clinical data of patients after OPCABG treated with ICU,studied the reasons for the prolongation of retention time in ICU,and explored the mechanism and the possibility of improving the work flow of diagnosis and treatment,so as to provide reference for gradually improving the therapeutic effect of OPCABG.Methods: The clinical data of patients who underwent off-pump coronary artery bypass grafting during hospitalization in the first affiliated Hospital of Guangxi Medical University from December 1,2012 to March 1,2019 were collected.According to whether ICU stay was greater than 24 hours,the patients were divided into two groups: normal rehabilitation group and prolong ICU stay group,and the clinical characteristics of the two groups were compared.Second,According to the difference of ICU stay time,the prolong ICU stay group were further divided into three groups: prolong ICU stay subgroup 1(24 h < ICU stay? 48 h),prolong ICU stay subgroup 2(48 h < ICU stay? 72 h)and prolong ICU stay subgroup 3(ICU stay > 72 hours).The possible cause of the patient's stay in ICU,It includes the basic state before operation,the situation during operation and the possible complications or causes after operation.The main reasons for staying in ICU in the three subgroup patients were counted,and the preoperative and intraoperative factors in the three groups were analyzed by univariate analysis and multivariate analysis,and whether there were any factors affecting the prolongation of ICU stay time were analyzed.Results: There were 294 patients,251 males(85.4%),aged 61.0 ±8.0 years(the youngest was 32 years old and the oldest was 80 years old).There were 287 cases(97.6%)in prolong ICU stay group and 7 cases(2.4%)in normal rehabilitation group.The patients in the normal rehabilitation group had the following characteristics: better cardiac function before operation,no need to use IABP during the perioperative period,awake within a few hours after operation and endotracheal intubation smoothly,and no complications occurred after operation.In the prolong ICU stay group,infection,hypoxia,increased drainage,arrhythmias and low cardiac output syndrome were the main causes of ICU stay prolongation.There were 90 cases of infection(31.4%),82 cases of pulmonary infection(28.6%),29 cases of arrhythmia(10.1%),21 cases of increased drainage(7.3%)and 59 cases of low cardiac output syndrome(20.6%).After subgrouping the prolong ICU stay group,there were 109 patients(38.0%)in the prolong ICU stay subgroup 1 and the prolong ICU stay subgroup 3,and 69 patients(24.0%)in the prolong ICU stay subgroup 2.The results of comparison of the causes of ICU stay prolongation among the three subgroups showed that there were significant differences in the main causes of stay prolongation among three subgroups.The results of comparison of preoperative and intraoperative factors among the three prolong ICU stay subgroups showed that the factors with statistical difference were age(p < 0.007)and obesity(p < 0.030).After adjustment by multivariate analysis,there was significant difference in obesity between prolong ICU stay subgroup 2 and prolong ICU stay subgroup 1(OR=3.688,95% confidence interval 1.058-12.856,p < 0.041).There were significant differences in age(OR=1.062,95%confidence interval 1.024-1.101,p<0.001)and obesity(OR=4.879,95% confidence interval 1.528-15.579,p<0.007)between prolong ICU stay subgroup 3 and prolong ICU stay subgroup 1.Conclusion: The results showed that the main causes of ICU stay prolongation after OPCABG included infection,hypoxia,increased drainage volume,arrhythmia and low cardiac output syndrome.Older,obese patients were associated with longer ICU stay after OPCABG. |
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