体外循环心脏手术后急性呼吸窘迫综合征的临床特点及预后分析  

The clinical features and the analysis of prognosis risk factors in acute respiratory distress syndrome patients after cardiopulmonary bypass cardiac surgery

作　　者：黄立学 宋曼[1] 裴振业 刘妍[1] 尙蔚 曹向戎[3] 来永强[3] 朱光发[1] HUANG Lixue;SONG Man;PEI Zhenye;LIU Yan;SHANG Wei;CAO Xiangrong;LAl Yongqiang;ZHU Guangfa(Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Disea-ses,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸与危重症医学科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外监护室,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2018年第10期923-926,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生科研发展专项基金课题(2016-2-1052)

摘　　要：目的:分析体外循环(CPB)心脏术后急性呼吸窘迫综合征(ARDS)患者的临床特点,预后情况及危险因素。方法:回顾性分析2005年1月至2015年12月,于首都医科大学附属北京安贞医院心脏外科行体外循环心脏手术后发生ARDS的144例患者。记录患者围术期相关资料和预后情况,二元Logistic回归分析影响预后的危险因素。结果:CPB心脏手术后ARDS患者144例平均年龄55.3岁,其中男性98例,占68.1%。CPB术后ARDS患者病死率27.8%(40/144)。CPB心脏手术后发生ARDS的主要手术类型是大血管手术,占28.5%,其次是CABG联合瓣膜手术占18.8%,多瓣膜手术占17.3%。不同手术类型对于ARDS患者的气管插管时间和住ICU时间,差异无统计学意义。二元Logistic回归分析示低BMI、术后应用ECMO和CRRT是患者院内死亡的危险因素(P均<0.05)。结论:CPB心脏术后ARDS患者病死率高,低BMI、术后应用ECMO或CRRT的ARDS患者院内死亡风险更高。Objective： To analyze the clinical characters, prognosis and risk factors of acute respiratory distress syndrome（ARDS） after cardiopulmonary bypass（CPB） cardiac surgery. Methods： A retrospective analysis was conducted on the hospitalized patients with ARDS after CPB cardiac surgery in Beijing Anzhen hospital during January 2005 to December 2015. Perioperative data and prognosis were recorded. Risk factors of death were analyzed. Results： 144 patients developed ARDS after CPB cardiac surgery, the mean age of 144 patients was 55.3 years old, 98（68.1%） with male. The mortality of ARDS patients after CPB cardiac surgery was 27.8%. The main type of surgery in ARDS patients after CPB was aortic surgery,account for 28.5%. Followed by coronary artery bypass graft（CABG）with valve surgery, account for 18.8%. The ratio of multiple valve surgery is 17.3%. There was no significant difference in intubation time and ICU stay time among different surgical types for ARDS patients. Lower BMI, using extracorporeal membrane oxygenation（ECMO） or continuous renal replacement therapy（CRRT）after surgery were the independent risk factors of death in ARDS patients after CPB cardiac surgery（all P〈0.05）. Conclusion： Mortality of ARDS patients after CPB surgery was high. ARDS patients after CPB surgery with lower BMI, using ECMO or CRRT during the postoperative period have a higher risk for death in hospital.

关 键 词：体外循环 急性呼吸窘迫综合征 危险因素 

分 类 号：R54[医药卫生—心血管疾病]