瓣膜置换术后机械通气时间延长的危险因素分析  

Risk factors of prolonged mechanical ventilation after valve replacement surgery

作　　者：孙静[1,2] 宋静华[2] 姜楠[2] 

机构地区：[1]天津医科大学,天津300071 [2]天津胸科医院

出　　处：《山东医药》2012年第20期36-38,共3页Shandong Medical Journal

摘　　要：目的分析瓣膜置换术后机械通气时间延长(≥48 h)的危险因素。方法回顾我院2010年1月～2011年8月行心脏瓣膜置换术的518例患者的临床资料,并对术后机械通气辅助呼吸时间延长(≥48 h)的危险因素进行分析。结果手术后机械通气时间超过48 h的患者72例,发生率13.9%。单因素分析结果表明,患者的年龄、心功能分级、术前血浆BNP水平、射血分数、肺动脉收缩压、同期行冠状动脉旁路移植手术、主动脉内球囊反搏支持、体外循环时间、主动脉阻断时间、置换瓣膜的数量、术后使用多巴胺≥10μg/(kg.min)以及术后使用肾上腺素与患者术后机械通气时间延长相关(P<0.05或P<0.01),上述因素进入二元逐步Logistic回归分析,结果显示患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg.min)与术后机械通气时间延长独立相关(P<0.05或P<0.01)。结论瓣膜置换术后机械通气时间延长的影响因素较多,其中患者的心功能分级、肺动脉收缩压和术后使用多巴胺≥10μg/(kg.min)是患者术后机械通气时间延长的独立危险因素。Objective To evaluate the clinical risk factors of prolonged mechanical ventilation after valve replacement surgery.Methods A total of 518 patients who underwent valve replacement between Jan 2010 and Aug 2011 were studied retrospectively.And the risk factors of prolonged mechanical ventilation（≥48 h） after valve replacement surgery were evaluated.Results Prolonged mechanical ventilation occurred in 13.9% patients after valve replacement surgery.Univariate analysis showed that,patients＇age,cardiac function,BNP level,ejection fraction,pulmonary artery pressure,concomitant CABG surgery,IABP usage,cardiopulmonary bypass time,aortic cross-clamp time,number of valve replacement,use of dopamine ≥ 10 μg/（kg·min） and use of epinephrine are related to prolonged mechanical ventilation after valve replacement surgery（P〈0.05 or P〈0.01）.Binary logistic regression analysis showed that,cardiac function,pulmonary artery pressure and use of dopamine ≥10 μg/（kg·min） are independently associated with prolonged mechanical ventilation after valve replacement surgery（P〈0.05 or P〈0.01）.Conclusion Patients＇ cardiac function,pulmonary artery pressure and use of dopamine ≥10 μg/（kg·min） are risk factors of prolonged mechanical ventilation after valve replacement surgery.

关 键 词：瓣膜置换手术 机械通气时间延长 危险因素 

分 类 号：R654.2[医药卫生—外科学]