单纯瓣膜置换术后机械通气时间延长的危险因素分析以及对临床预后的影响  

Risk factors for prolonged mechanical ventilation after isolated heart valve replacement and its effect on clinical prognosis

作　　者：徐先增[1] 刘阳春[1] 钱靖[1] 周婷[1] 谢晓勇[1] 雷宾峰[1] 冯旭[1] 郑宝石[1] Xian-zeng Xu;Yang-chun Liu;Jing Qian;Ting Zhou;Xiao-yong Xie;Bin-feng Lei;Xu Feng;Bao-shi Zheng(Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University,Nanning, Guangxi 530021, China)

机构地区：[1]广西医科大学第一附属医院心胸外科,广西南宁530021

出　　处：《中国现代医学杂志》2017年第28期91-95,共5页China Journal of Modern Medicine

摘　　要：目的探究单纯瓣膜置换(HVPI)术后机械通气时间延长(PMV)的发生率、危险因素以及对临床预后的影响。方法回顾性分析该院心胸外科2013年度的HVPI的400例患者。记录术前、术中以及术后等多种变量,进行单因素和多因素分析。呼吸机时间延长定义为术后呼吸机应用时间>24 h。结果 PMV患者87例(21.8%)。单因素分析发现非PMV组(A组)与PMV组(B组)患者在总胆红素水平、心功能Ⅲ~Ⅳ级、左室舒张末径、左室射血分数、转机时间、手术当天引流量、血红蛋白、血清肌酐、血糖、乳酸等方面,差异有统计学意义(P<0.05)。多因素分析发现LVEF>50%(OR=0.051,95%CI:0.005~0.541,P=0.014)是避免术后PMV的保护因素,而转机时间>120 min(OR=2.144,95%CI:1.061~4.335,P=0.034)、术后24 h肌酐>133μmol/L(OR=2.979,95%CI:1.463~6.069,P=0.003)和乳酸>5 mmol/L(OR=4.379,95%CI:2.115~9.067,P=0.000)是导致术后PMV的危险因素。术后PMV患者组患者术后死亡率(OR=8.0,95%CI:1.4~44.3,P=0.019)和ICU>2 d(OR=9.4,95%CI:5.4~16.3,P=0.000)的风险较对照组增加。结论 HVPI术后PMV与左心收缩功能、转机时间、术后早期肌酐和乳酸水平等多因素相关,PMV可导致术后死亡率增加和ICU滞留时间延长。Objective To investigate the incidence and risk factors of prolonged mechanical ventilation(PMV)in patients undergoing isolated heart valve prosthesis implantation(HVPI)and its influence on patients’prognosis.Methods Totally400patients who underwent HVPI in the Department of Cardiothoracic Surgery ofour hospital in2013were analyzed retrospectively.Preoperative,intraoperative and postoperative variables wereanalyzed as risk factors.PMV was defined as time of postoperative ventilation>24hours.Results There were87patients(21.8%)who matched the diagnosis criterion of PMV.Univariate analysis showed that preoperative totalbilirubin,heart function in grade III-IV,left ventricular end diastolic diameter,left ventricular ejection fraction(LVEF),cardiopulmonary bypass time,postoperative drainage volume,hemoglobin,serum creatinine,glucose and lactate(within24hours after HVPI)were significantly different between the non-PMV group(group A)and the PMVgroup(group B,all P<0.05).Multivariate analysis showed that LVEF>50%(Ol^R=0.051,95%CI:0.005-0.541;P=0.014)was an independent protective factor for postoperative PMV,but cardiopulmonary bypass time>120min(Ol^R=2.144,95%CI:1.061-4.335;P=0.034),postoperative creatinine>133mol/L(Ol^R=2.979,95%CI:1.463-6.069;P=0.003)and lactic acid>5mmol/L(Ol^R=4.379,95%CI:2.115-9.067;P=0.000)were the independentrisk factors for PMV after HVPI surgery.The PMV group had significantly increased risks of postoperative mortality(Ol^R=8.0,95%CI:1.4-44.3;P=0.019)and ICU stay time>2days(Ol^R=9.4,95%CI:5.4-16.3;P=0.000)compared with the control group.Conclusions Left ventricular systolic function,cardiopulmonary bypass time,postoperative level of creatinine and lactic acid are separately associated with PMV after HVPI.PMV can lead toincreased postoperative mortality and prolonged ICU stay time.

关 键 词：心脏瓣膜置换术 机械通气 危险因素 预后 

分 类 号：R654.2[医药卫生—外科学]