中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

成人房室间隔缺损矫治术术后延迟拔管危险因素分析

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目的 探索房室间隔缺损矫正术术后延迟拔管的危险因素。 方法 回顾性分析 2011 年 1 月 1 日至 2017 年 12 月 31 日于阜外医院第二住院部接受房室间隔缺损矫正术 76 例成年(年龄≥18)患者的临床资料。以呼吸机支持是否大于 24 h 为标准,将患者分为延迟脱机组(27 例)和正常脱机组(49 例)。采用单因素分析法比较两组之间的差异性变异。将单因素分析中 P<0.05 变量纳入二元 logistic 模型,用以分析变量的显著性差异。 结果 单因素分析结果显示:延迟脱机组和正常脱机组患者在体质量、术前肺动脉收缩压;体外循环时间;术后血小板、血红蛋白、血肌酐、血糖、血乳酸、术后最大心率及术后肺部感染发生率差异有统计学差异。二元 logestic 回归显示,延迟脱机的独立危险因素包括术前肺动脉高压[OR=1.056,95%CI(1.005,1.110),P=0.03]、体外循环时间延长[OR=1.036,95%CI(1.007,1.066),P=0.016]以及术后血红蛋白减少[OR=0.874,95%CI(0.786,0.973),P=0.014]。 结论 术前肺动脉高压、体外循环时间延长和术后贫血是成人房室间隔缺损修补术术后脱机困难的独立危险因素。

Objective To investigate the risk factors for prolonged postoperative mechanical ventilation patients with atrioventricular septal defect (AVSD). Methods We retrospectively analyzed the clinical data of 76 patients with atrioventricular septal defect aged more than 18 years in our hospital from January 1st 2011 to December 31st 2017.The patients ventilated longer than 24 hours were described as a prolonged ventilated group (n=27) and the others as a normal group (n=49). Perioperative variables between the two groups were compared and selected, then put into logistic regression analysis. Results The result of univariate analysis showed that there was a statistical difference in weight, preoperative pulmonary artery systolic pressure, during of cardiopulmonary bypass, the level of postoperative platelet, HGB, blood glucose, lactic acid and serum creatinine, postoperative maximum heart rate and postoperative infection rate between the prolonged ventilated group and the normal group. Multivarable logistic regression showed that preoperative pulmonary artery hypertension (OR=1.056, 95%CI 1.005 to 1.110, P=0.03), prolonged during of CPB (OR=1.036, 95%CI 1.007 to 1.066, P=0.016) and the lower postoperative HGB level (OR=0.874, 95%CI 0.786 to 0.973, P=0.014) were the risk factors for prolonged postoperative mechanical. Conclusion Preoperative pulmonary artery hypertension, longer time of CPB and postoperative anaemia are the risk factors associated with prolonged postoperative mechanical ventilation.

关键词: 成人先心病; 房室间隔缺损; 围术期; 机械通气

Key words: Adult congenital heart disease; atrioventricular septal defect; perioperative period; mechanical ventilation

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