The Effect Of Preoperative Quitting Time Of Postoperative Hypoxemia In Patients With Elective Coronary Arterie Bypass Grafting

Objective:Analysis of coronary artery bypass surgery patients before quitting affect the duration of postoperative incidence of hypoxemia, provide a theoretical basis for the pre-surgery medical staff of health education.Method:1. The patients with a history of smoking who in front of our hospital for cardiovascular surgery and coronary artery bypass graft surgery in September 2011 to 2013.According to the preoperative smoking cessation quit smoking dvided 0 days, 1~30 day, 31~60 days, 61~90 days, > 90 days five groups. collect the information of five groups patients. Includes general information: age, weight, degree of culture; Smoking: smoking years count, preoperative quitting time. Clinical data: EF value, lung function whether lung ventilation(reserves), hypertension, diabetes mellitus, intraoperative bypass count, operation time. Five patients adopt Germany GEMpremier3000 blood gas machine for measuring analysis of arterial blood oxygen partial pressure. By a trained nurse intensive care unit, of arterial blood collection in arterial blood oxygen partial pressure < [102-(0.33×age)mm Hg] is a standard, appear less than 1 times of postoperative oxygen partial pressure[102-(0.33×age)mm Hg].that is, the occurrence of hypoxemia, five patients postoperative hypoxemia is happening.2. Using SPSS 21.0 software for statistical analysis, in line with the normal distribution of measurement data to`c±s said that if the homogeneity of variance between groups using two independent sample t test, if the choice of heterogeneity of variance t ’test. Count data using the number(percentage) cases that the groups were compared using the χ2 test. Because univariate analysis did not consider the interaction between the factors and the factors, so we chose logistic regression model was an independent risk factor analysis, and in order to reduce the lack of important factors in the statistical analysis, we will univariate analysis on the basis of P <0.1, all risk factors into a multivariate logistic regression model established, the application of stepwise method with α=0.05, P<0.05 was considered statistically significant, progressive independent risk factor screening. Meanwhile, the five groups of patients the incidence of postoperative hypoxemia group and group chi-square test, using the Monte Carlo method to adjust the value of χ2 sector, reducing the probability of error committed class 1, five groups of patients were analyzed hypoxia Are there differences in the incidence of hyperlipidemia, with P<0.05 was considered statistically significant.Results:1. Age( OR=1.036; 95%CL,0.911-0.991; P=0.004),weight( OR=2.135;95%CL, 1.034-1.067; P=0.017), smoking years count(OR=3.510; 95%CL, 1.971-6.271; P<0.001), quit smoking(OR=0.277; 95%CL, 0.1610.467; P<0.001) is an independent risk factor of postoperative hypoxemia.2. Stop smoking group five patients the incidence of postoperative hypoxemia respectively: 59.26%、55.56%、27.58%、22.73%、15.62%. Quit smoking day 0 higher incidence of hypoxemia group 31~60 days(χ2 = 4.519, P< 0.05), 61~90 days group(χ2 = 5.408, P< 0.05), > 90 days(χ2 = 10.42, P< 0.05), and there was no statistically significant difference stop smoking group 1~30 days(χ2 = 0.076, p > 0.076). Quit smoking 1-30 days to higher incidence of hypoxemia group 31-60 days(χ2 = 5.728, P< 0.05), 61~90 days group(χ2 = 6.606, P< 0.05), > 90 days(χ2 = 12.162, P< 0.05); Preoperative smoking 31 to 60 days group, the incidence of hypoxemia group with 61-61 days(χ2 = 0.156, P> 0.156), and quit smoking > 90 days group(χ2 = 1.298, P> 1.298) difference is not significant. Quit smoking > 90 days set the lowest incidence of hypoxemia.Conclusion:1. Age, Weight, Smoking years count, Quit smoking were independent risk factors of hypoxemia after coronary artery bypass grafting.2. Quit smoking day group, the incidence of hypoxemia and 1 0 ~ 30 days group, 31 to 60 days, 61 ~ 90 days, 90 days > group have obvious difference. Therefore, we suggest that CABG patients with preoperative to stop smoking.3. CABG patients with preoperative as far as possible to quit smoking, quit smoking for a short period of time can reduce the incidence of postoperative hypoxemia. there was no difference in the incidence of postoperative hypoxemia CABG patients with 1 ~ 2 month and 3 month.4.Different quitting time, coronary artery bypass surgery is different influence on the incidence of postoperative hypoxemia, coronary bypass patients of preoperative smoking intervention of timely and effective to reduce the incidence of postoperative hypoxemia.