老年患者冠状动脉旁路移植术后呼吸功能衰竭的危险因素分析  

Predictive Risk Factors for Postoperative Respiratory Failure in Elderly Patients undergoing Coronary Artery Bypass Grafting Surgery

作　　者：韩忠[1] 卢钦安[1] 李跃华[2] 巩性军[2] 

机构地区：[1]山东中医药大学第二附属医院急救中心,济南250001 [2]山东大学齐鲁医院心脏外科,济南250012

出　　处：《中国现代医生》2009年第15期10-11,19,共3页China Modern Doctor

摘　　要：目的探讨老年患者冠状动脉旁路移植(CABG)术后发生呼吸功能衰竭的危险因素。方法收集两院自2001年1月～2008年5月年龄均超过60岁的CABG患者389例,按术后有无呼吸功能衰竭分为两组,进行单因素分析和多因素Logistic回归分析,术后机械通气48h以上或全麻拔管6h后再次插管行机械通气视为呼吸衰竭。结果出现术后呼吸功能衰竭21例(5.4%);单因素分析发现年龄、吸烟、慢性阻塞性肺疾病病史、合并瓣膜病、心功能、射血分数、心胸比率、术前呼吸功能减退、氧分压、是否采用体外循环、体外循环时间、主动脉阻断时间以及术后氧合指数与发生术后呼吸功能衰竭有关;经多因素Logistic回归分析发现,年龄≥70岁、术前最大通气量减退、术中体外循环支持、同期心脏瓣膜手术以及术后第2小时血气氧合指数低于300mmHg为CABG术后发生呼吸功能衰竭的危险因素。结论临床上可根据年龄、术前最大通气量、术中体外循环支持、术后血气氧合指数预测CABG术后呼吸功能衰竭,以便预先采取措施。Objective To analyze risk factors associated with postoperative respiratory failure （ PRF ） after coronary artery bypass grafting （CABG） surgery. Methods Between January 2001 and May 2007,389 patients（60 years of age or older） with CABG were examined retrospectively. Multiple perioperative factors were evaluated by univariate and multivariate logistic regression analysis. PRF was defined as mechanical ventilation lasting for more than 48 hours after operation or reintubation and mechanical ventilation 6 hours later after extubation. Results Twenty one patients（5.4%） developed PRF. Univariate risk factors included age, smoking,history of chronic obstructive pulmonary disease （COPD）, combined heart valve disease, NYHA functional class Ⅲ or Ⅳ, ejection fraction, cardiothoracic ratio, preoperative respiratory function decrudescence, oxygen partial pressure, whether or not using cardiopulmonary bypass, cardiopulmonary bypass （CPB） time, aortic cross clamping time,low ratio of arterial oxygen tension to inspired oxygen fraction（PaOJFiO2） at postoperative second hour. Multivariate logistic regression analysis identitied that age ≥ 70 years, preoperative maximal voluntary ventilation（MVV） decrudescence, CPB support, combined heart valve operation,the postoperative second hour PaO2/FiO2 〈 300mmHg were risk factors. Conclusion The results of this study suggest that patients with risk factors described above need more careful surveillance and management.

关 键 词：冠状动脉旁路移植术 呼吸功能不全 危险因素 老年 

分 类 号：R563.8[医药卫生—呼吸系统]