心脏瓣膜置换术后ARDS发生原因及相关影响因素分析  

Analysis of the causes and related influencing factors of ARDS after heart valve replacement

作　　者：赵义熙 梁贵友 刘颖清 ZHAO Yixi;LIANG Guiyou;LIU Yingqing(Department of Cardiothoracic Surgery,Central Hospital of Mianyang City,Mianyang,Sichuan 621000,China;Department of Cardiovascular Surgery,the Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China;School of Nursing, Gongqing Institute of Science and Technology,Jiujiang,Jiangxi 332000,China)

机构地区：[1]四川省绵阳市中心医院心胸外科,621000 [2]遵义医科大学附属医院心脏大血管外科,贵州遵义563000 [3]共青科技职业学院护理学院,江西九江332000

出　　处：《重庆医学》2020年第18期3058-3062,共5页Chongqing medicine

基　　金：贵州省科技攻关重点项目(黔科合SZ字[2014]3022号)。

摘　　要：目的分析心脏瓣膜置换术后急性呼吸窘迫综合征(ARDS)的危险因素。方法对遵义医科大学附属医院心血管外科2013年10月至2017年10月对在体外循环(CPB)下行心脏瓣膜置换术的病例进行回顾性分析。根据“柏林标准”将586例患者分为ARDS组和非ARDS组。对两组患者的临床资料进行单因素分析。而后,将单因素分析中差异有统计学意义的因素纳入logistic回归分析,确定是否为ARDS的独立危险因素。结果586例行心脏瓣膜置换术患者中ARDS组24例,非ARDS组562例,发病率为4.1%,病死率20.83%。单因素分析显示年龄,心功能纽约心脏病学会(NYHA)分级Ⅳ级、术前合并脑梗死、既往心脏手术史、术中出血量、术中输血量、置换生物瓣、右侧开胸、CBP时间在两组间差异有统计学意义(P<0.05)。logistic回归分析结果显示年龄、既往心脏手术史、右侧开胸、CPB时间、术中输血量是ARDS的独立危险因素(P<0.05)。ARDS组院内病死率、ICU滞留时间、术后机械通气时间较非ARDS组高(P<0.05)。结论心脏瓣膜置换术后ARDS发生会增加患者住院期间病死率、增加ICU滞留时间、增加机械通气时间。年龄、既往心脏手术史、右侧开胸、CBP时间、术中输血量是ARDS发生的独立危险因素。Objective To analyze the risk factors of acute respiratory distress syndrome(ARDS)after heart valve replacement.Methods A retrospective analysis of cases of heart valve replacement under cardiopulmonary bypass(CPB)from October 2013 to October 2017 in the Department of Cardiovascular Surgery,the Affiliated Hospital of Zunyi Medical University was done.According to the"Berlin Standard",586 patients were divided into the ARDS group and the non-ARDS group.Univariate analysis was performed on the clinical data of the two groups of patients.Then,factors with statistical significance in univariate analysis were included in logistic regression analysis to determine whether they were independent risk factors for ARDS.Results A total of 586 patients underwent heart valve replacement,including 24 patients in the ARDS group and 562 patients in the non-ARDS group.The incidence of ARDS was 4.1%and the mortality rate was 20.83%.Univariate analysis showed that age,NYHA gradeⅣ,history of previous cerebral infarction,history of cardiac surgery,the introperative blood loss,massive infusion of plasma,use of biological valves,thoracotomy at right side,and time of CPB were related to ARDS(P<0.05).Logistic multivariate regression analysis showed that age,history of cardiac surgery,right thoracotomy at right side,massive infusion of plasma,time of CBP were the independent risk factors of ARDS after heart valve replacement surgery(P<0.05).Postoperative mortality,the ICU retention time and the mechanical ventilation time after operation were higher in the ARDS group thanin the non-ARDS group(P<0.05).Conclusion ARDS after heart valve replacement can increase the mortality rate during hospitalization,increase the ICU retention time,and increase the mechanical ventilation time after operation.Age,history of cardiac surgery,right thoracotomy,massive infusion of plasma,time of CPB were independent risk factors for ARDS.

关 键 词：心脏瓣膜假体植入 呼吸窘迫综合征 成人 危险因素 LOGISTIC模型 

分 类 号：R654.2[医药卫生—外科学]