Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIANG Yuping ,  ZENG Ling , LUO Tianhui , HUANG Kaiqin

Department of Intensive Care Unit/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

ZENG Ling, Email: zengling510@163.com

Keywords：

Coronary artery bypass grafting; hypoxemia; risk factor; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202001074

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Objective To systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting (CABG).Methods Eight electronic databases including PubMed, EMbase, CENTRAL, Web of Science, CNKI, CBM, VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020. Two authors independently assessed the quality using the Newcastle-Ottawa Scale (NOS), and a meta-analysis was performed by RevMan 5.3 software.Results A total of 15 studies involving 4 277 patients were included in this study and among them 1 273 patients suffered hypoxemia. Meta-analysis showed that age (OR=1.55, 95%CI 1.22 to 1.96, P=0.000 3), smoking (OR=3.22, 95%CI 2.48 to 4.17, P<0.000 01), preoperative chronic pulmonary diseases (OR=4.75, 95%CI 3.28 to 6.86, P<0.000 01), diabetes (OR=2.49, 95%CI 1.86 to 3.33,P<0.000 01), left ventricular ejection fraction (OR=3.15, 95%CI 2.19 to 4.52, P<0.000 01), number of coronary artery lesions (OR=2.20, 95%CI 1.63 to 2.97, P<0.000 1) were independent risk factors for hypoxemia after CABG; body mass index (OR=1.31, 95%CI 0.97 to 1.77, P=0.08) and cardiopulmonary bypass time (OR=3.40, 95%CI 0.72 to 15.94, P=0.12) were not associated with hypoxemia.Conclusion Current evidence shows that age, preoperative chronic pulmonary diseases, smoking, diabetes, left ventricular ejection fraction, number of coronary artery are risk factors for hypoxemia after CABG, which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia. The results should be validated by large-scale standard studies in the future.

Citation： XIANG Yuping, ZENG Ling, LUO Tianhui, HUANG Kaiqin. Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 926-932. doi: 10.7507/1007-4848.202001074 Copy

1.	Stephens RS, Shah AS, Whitman GJ. Lung injury and acute respiratory distress syndrome after cardiac surgery. Ann Thorac Surg, 2013, 95(3): 1122-1129.
2.	Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
3.	Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-370.
4.	李連鎮, 梅舉, 何毅, 等. 非體外循環冠脈搭橋術后早期重度低氧血癥的風險預測模型探索. 中國心血管病研究, 2017, 15(3): 227-230.
5.	Wang SP, Li M, Yi L, et al. The impact of early hypoxemia on the prognosis of patients undergone general anesthesia patients in intensive care unit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2013, 25(10): 600-603.
6.	Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
7.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
8.	Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
9.	栗志勇, 常俊偉, 張悟麟, 等. 被動吸煙對冠狀動脈搭橋術后低氧血癥的影響. 醫學研究與教育, 2018, 35(1): 31-36.
10.	Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11.	何軍. 非體外循環下冠脈搭橋術后低氧血癥的分析及治療. 河北大學, 2017.
12.	郭炯. 非體外循環下冠狀動脈搭橋術后低氧血癥的危險因素分析及肺復張治療. 鄭州大學, 2018.
13.	沈亮, 陸晨希, 仲崇俊. 非體外循環下冠狀動脈旁路移植術后低氧血癥的危險因素分析. 解放軍醫學院學報, 2014, 35(1): 49-51, 91.
14.	張憲芬, 高文根, 張殿寶, 等. 冠脈搭橋術后低氧血癥相關分析. 中國醫藥科學, 2015, 5(16): 139-141.
15.	馮靖, 季強, 梅運清, 等. 冠狀動脈旁路移植術后低氧血癥的相關因素分析. 同濟大學學報: 醫學版, 2012, 33(5): 53-57.
16.	沈立, 薛松, 汪永義. 冠狀動脈旁路移植術后低氧血癥危險因素研究. 中國心血管病研究, 2014, 12(2): 102-106.
17.	宋冀東, 閆繼東. 老年冠狀動脈旁路移植術后低氧血癥的危險因素. 中國老年學雜志, 2015, 35(8): 2019-2021.
18.	許衛江, 陳祖君, 肖紅艷, 等. 體外循環冠狀動脈旁路移植術后低氧血癥的危險因素分析. 中國綜合臨床, 2011, 27(3): 249-252.
19.	朱曉敏. 術前戒煙時間對擇期冠脈搭橋患者術后低氧血癥發生率的影響. 河南科技大學, 2015.
20.	程國棟, 朱春磊, 李小芳, 等. 37 例非體外循環冠狀動脈搭橋術后低氧血癥的危險因素分析. 臨床醫學, 2019, 39(10): 47-49.
21.	王賀之. 非體外循環冠狀動脈旁路移植術后低氧血癥相關因素分析. 河北醫科大學, 2016.
22.	Xu F, Zhuang J, Wang R, et al. Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema. Respir Physiol Neurobiol, 2007, 158(1): 5-13.
23.	Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis, 2011, 6(6): 199-208.
24.	Xiong XQ, Wang WT, Wang LR, et al. Diabetes increases inflammation and lung injury associated with protective ventilation strategy in mice. Int Immunopharmacol, 2012, 13(3): 280-283.
25.	Hickson DA, Burchfiel CM, Liu J, et al. Diabetes, impaired glucose tolerance, and metabolic biomarkers in individuals with normal glucose tolerance are inversely associated with lung function: the Jackson Heart Study. Lung, 2011, 189(4): 311-321.
26.	Mirzaaghazadeh M, Bahtouee M, Mehdiniya F, et al. The relationship between nocturnal hypoxemia and left ventricular ejection fraction in congestive heart failure patients. Sleep Disord, 2014, 2014: 978358.

1. Stephens RS, Shah AS, Whitman GJ. Lung injury and acute respiratory distress syndrome after cardiac surgery. Ann Thorac Surg, 2013, 95(3): 1122-1129.
2. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
3. Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-370.
4. 李連鎮, 梅舉, 何毅, 等. 非體外循環冠脈搭橋術后早期重度低氧血癥的風險預測模型探索. 中國心血管病研究, 2017, 15(3): 227-230.
5. Wang SP, Li M, Yi L, et al. The impact of early hypoxemia on the prognosis of patients undergone general anesthesia patients in intensive care unit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2013, 25(10): 600-603.
6. Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
7. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
8. Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
9. 栗志勇, 常俊偉, 張悟麟, 等. 被動吸煙對冠狀動脈搭橋術后低氧血癥的影響. 醫學研究與教育, 2018, 35(1): 31-36.
10. Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11. 何軍. 非體外循環下冠脈搭橋術后低氧血癥的分析及治療. 河北大學, 2017.
12. 郭炯. 非體外循環下冠狀動脈搭橋術后低氧血癥的危險因素分析及肺復張治療. 鄭州大學, 2018.
13. 沈亮, 陸晨希, 仲崇俊. 非體外循環下冠狀動脈旁路移植術后低氧血癥的危險因素分析. 解放軍醫學院學報, 2014, 35(1): 49-51, 91.
14. 張憲芬, 高文根, 張殿寶, 等. 冠脈搭橋術后低氧血癥相關分析. 中國醫藥科學, 2015, 5(16): 139-141.
15. 馮靖, 季強, 梅運清, 等. 冠狀動脈旁路移植術后低氧血癥的相關因素分析. 同濟大學學報: 醫學版, 2012, 33(5): 53-57.
16. 沈立, 薛松, 汪永義. 冠狀動脈旁路移植術后低氧血癥危險因素研究. 中國心血管病研究, 2014, 12(2): 102-106.
17. 宋冀東, 閆繼東. 老年冠狀動脈旁路移植術后低氧血癥的危險因素. 中國老年學雜志, 2015, 35(8): 2019-2021.
18. 許衛江, 陳祖君, 肖紅艷, 等. 體外循環冠狀動脈旁路移植術后低氧血癥的危險因素分析. 中國綜合臨床, 2011, 27(3): 249-252.
19. 朱曉敏. 術前戒煙時間對擇期冠脈搭橋患者術后低氧血癥發生率的影響. 河南科技大學, 2015.
20. 程國棟, 朱春磊, 李小芳, 等. 37 例非體外循環冠狀動脈搭橋術后低氧血癥的危險因素分析. 臨床醫學, 2019, 39(10): 47-49.
21. 王賀之. 非體外循環冠狀動脈旁路移植術后低氧血癥相關因素分析. 河北醫科大學, 2016.
22. Xu F, Zhuang J, Wang R, et al. Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema. Respir Physiol Neurobiol, 2007, 158(1): 5-13.
23. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis, 2011, 6(6): 199-208.
24. Xiong XQ, Wang WT, Wang LR, et al. Diabetes increases inflammation and lung injury associated with protective ventilation strategy in mice. Int Immunopharmacol, 2012, 13(3): 280-283.
25. Hickson DA, Burchfiel CM, Liu J, et al. Diabetes, impaired glucose tolerance, and metabolic biomarkers in individuals with normal glucose tolerance are inversely associated with lung function: the Jackson Heart Study. Lung, 2011, 189(4): 311-321.
26. Mirzaaghazadeh M, Bahtouee M, Mehdiniya F, et al. The relationship between nocturnal hypoxemia and left ventricular ejection fraction in congestive heart failure patients. Sleep Disord, 2014, 2014: 978358.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis

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