婴幼儿先天性心脏病合并肺动脉高压术后延迟拔管的危险因素分析  

Risk factors for postoperative delayed extubation in infants with congenital heart disease and pulmonary hypertension

作　　者：何思毅 王宪颖 殷小强 卢忠杰 陈杰 刘敬臻 张近宝 He Siyi;Wang Xianying;Yin Xiaoqiang;Lu Zhongjie;Chen Jie;Liu Jingzhen;Zhang Jinbao(Department of cardiovascular surgery,General Hospital of Western Theater Command,Sichuan Chengdu 610083,China)

机构地区：[1]西部战区总医院心外科,四川成都610083 [2]川北医学院,四川南充637100

出　　处：《中国体外循环杂志》2020年第1期17-20,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨导致婴幼儿先天性心脏病(CHD)合并肺动脉高压(PAH)患者术后出现延迟拔管的危险因素及其对临床结局的影响。方法回顾性分析2016年1月至2018年12月在本科行心肺转流(CPB)心脏手术的3岁以内婴幼儿患者,所有诊断均为CHD合并PAH。术后机械通气时间大于24 h者纳入延迟组,反之则纳入非延迟组。结果共纳入286例患儿,其中延迟组81例、非延迟组205例。单因素分析结果提示术前肺动脉压力、气管插管及术中CPB时间、自动复跳均与延迟拔管的发生显著相关(P<0.05)。进一步行多因素logistic回归分析,发现术前肺动脉压力、术前气管插管、术后第一日C反应蛋白是延迟拔管的独立危险因素。一旦出现延迟拔管,其ICU停留时间及总住院日将会显著增高(P<0.05)。结论婴幼儿CHD合并PAH会导致延迟拔管进而显著影响患儿的临床预后,通过对其发生的危险因素进行分析,可为优化术后监护提供依据。Objective The present study intends to explore risk factors for postoperative delayed extubation in infants with congenital heart disease(CHD)and pulmonary artery hypertension(PAH),and its effect on clinical outcomes.Methods Retrospective analysis was conducted on infants under 3 years old who underwent cardiopulmonary bypass heart surgery in our department from January 2016 to December 2018.All patients were diagnosed as CHD combined with PAH.Patients with mechanical ventilation time longer than 24 h were included in the delayed group,while the others were included in the non-delayed group.Results A total of 286 children were enrolled,including 81 in the delayed group and 205 in the non-delayed group.Univariate analysis indicated that preoperative pulmonary artery pressure,endotracheal intubation,as well as intraoperative cardiopulmonary bypass time and automatic re-beating rate were significantly correlated with delayed extubation(P<0.05).Furthermore,multivariate logistic regression analysis showed that preoperative pulmonary artery pressure,preoperative endotracheal intubation,and C-reaction protein on the first postoperative day were independent risk factors for delayed extubation.Once delayed extubation appeared,the length of ICU stay and total length of hospital stay would be significantly increased.Conclusion Postoperative delayed extubation in infants with CHD and PAH can significantly affect the clinical prognosis.By analyzing its risk factors,it can provide the basis for optimizing postoperative care.

关 键 词：先天性心脏病 肺动脉高压 心脏手术 心肺转流 婴幼儿 延迟拔管 

分 类 号：R54[医药卫生—心血管疾病]