心内直视手术后急性呼吸窘迫综合征发生的危险因素  

Risk factors associated with ARDS following cardiopulmonary bypass

作　　者：陈柏成[1] 肖颖彬[1] 钱桂生[2] 陈林[1] 钟前进[1] 王学锋[1] 

机构地区：[1]第三军医大学附属新桥医院心血管外科,重庆400037 [2]第三军医大学附属新桥医院全军呼吸内科研究所

出　　处：《中华急诊医学杂志》2006年第5期429-432,共4页Chinese Journal of Emergency Medicine

基　　金：全军医药卫生科研基金课题资助项目(01Z074)

摘　　要：目的分析心内直视手术后急性呼吸窘迫综合症(ARDS)发生的危险因素,以提高心内直视手术后呼吸并发症的救治水平。方法采用自行设计的心脏外科数据库收集本院在1996年1月至2004年3 月期间ICU收治的52例ARDS患者的临床资料,并采用配比方法按1∶6选择同期手术、病种类似而术后未发生ARDS的心内直视手术的患者行二分类Logistic回归分析,评价各影响因素的作用大小。结果本组 ARDS患者死亡率为21．2％。经二分类Logistic回归分析结果显示:术前肾功能不全(OR=6．443)、肥胖 (OR=14．331)、术前存在合并疾病(OR=11．455)、围术期出现了意外情况(OR=7．988)、术后引流多 (OR=3．804)、术后输血量大(OR=9．763)等是心内直视手术后发生ARDS的危险因素。结论针对具有 ARDS高危因素的心内直视手术患者,采取积极的防范措施,对防止心内直视手术后发生ARDS及对早期诊断和处理具有重要的实际意义。Objective To study the risk factors associated with acute respiratory distress syndrome （ARDS） after cardiopulmonary bypass, and to improve the treatment. Methods From January 1996 to March 2004, 52 patients developed ARDS in our ICU. The clinical data of the patients were collected in cardiovascular surgery database designed by our work team. The number in the control group was 6 time that in the ARDS group. Patients in the control group underwent similar operations during the same period without ARDS. The binary Logistic regression analysis model was used to evaluate the variables. Results Mortality of ARDS group was 21.2% . Binary Logistic regression analysis showed that preoperative renal dysfunction （ OR = 6.443）, excess large BW （ OR = 14.331）, preoperative coexisting disease （ OR = 11.455）, pefioperative unexpected events or other postoperative complications （ OR = 7.988）, large quantity of chest drainage （ OR = 3. 804 ）, and larger quantity of blood transfusion （ OR = 9.763 ） were the independent risk factors of ARDS following open heart operation. Conclusion Active and effective treatments should be carried out in the patients with high risk factors of ARDS following open heart operation. It would play an important role in the prevention, early diagnosis and management of ARDS.

关 键 词：心内直视手术 急性呼吸窘迫综合征 二分类Logistic回归分析 危险因素 

分 类 号：R654.2[医药卫生—外科学] R563.8[医药卫生—临床医学]