胸腔镜心脏手术后复张性肺水肿发生危险因素分析  

Risk factors of reexpansion pulmonary edema after thoracoscopic cardiac surgery

作　　者：丁晓燕 陈远翔[2,3] 吴丽敏 林风辉[1,2] DING Xiaoyan;CHEN Yuanxiang;WU Limin;LIN Fenghui(The Fourth Department of Critical Care Medicine,Fujian Provincial Hospital,Fuzhou350001,China;Provincial Clinical Medical College of Fujian Medical University,Fuzhou350001,China;The Second Department of Extracardiac Surgery,Fujian Provincial Hospital,Fuzhou350001,China)

机构地区：[1]福建省立医院重症医学四科,福建福州350001 [2]福建医科大学省立临床医学院,福建福州350001 [3]福建省立医院心外二科,福建福州350001

出　　处：《中国现代医生》2022年第1期103-106,共4页China Modern Doctor

摘　　要：目的探讨分析胸腔镜心脏手术患者术后复张性肺水肿发生的危险因素。方法回顾分析2017年7月至2020年12月福建省立医院采用胸腔镜治疗心脏外科疾病的70例患者临床资料;依据术后肺部渗出情况及24 h内的氧合指数评估患者术后是否发生复张性肺水肿。将70例患者分为复张性肺水肿(REPE)组(n=20)与非复张性肺水肿(NREPE)组(n=50)。比较REPE组和NREPE组患者的基线资料和围术期指标,并用logistic回归分析胸腔镜心脏手术术后患者发生复张性肺水肿的危险因素。结果胸腔镜术后复张性肺水肿发生率28.57%。回归分析结果显示,BMI(OR=1.684,95%CI:1.118~2.536,P=0.013)、合并糖尿病(OR=0.021,95%CI:0.001~0.828,P=0.039)、二次接受心脏手术(OR=0.039,95%CI:0.005~0.323,P=0.003)、体外循环时间(OR=1.016,95%CI:1.000~1.031,P=0.044)是胸腔镜心脏术后复张性肺水肿发生的危险因素(P<0.05)。NREPE组再次插管率、有创呼吸机使用时间、死亡率均低于REPE组(P<0.05)。结论胸腔镜心脏手术复张性肺水肿在围术期发生率较高,呼吸机使用时间明显延长,复张性肺水肿组较非复张性肺水肿组死亡率增高,BMI、糖尿病、体外循环时间等是胸腔镜术后复张性肺水肿的危险因素。Objective To explore and analyze the risk factors of reexpansion pulmonary edema(REPE)after thoracoscopic cardiac surgery.Methods The clinical data of 70 patients with cardiac diseases treated by thoracoscopy in Fujian Provincial Hospital from July 2017 to December 2020 were analyzed retrospectively.The postoperative pulmonary exudation and oxygenation index within 24 hours were used to assess whether patients develop REPE after surgery.Seventy patients were divided into two groups:REPE group(n=20)and non-reexpansion pulmonary edema(NREPE)group(n=50).The baseline data and perioperative indicators of patients in REPE group were compared with those in NREPE group,and the risk factors of REPE after thoracoscopic cardiac surgery were analyzed by logistic regression.Results The incidence of REPE after thoracoscopic surgery was 28.57%.Regression analysis showed that body mass index(BMI)(OR=1.684,95%CI:1.118-2.536,P=0.013),diabetes mellitus(OR=0.021,95%CI:0.001-0.828,P=0.039),the second cardiac surgery(OR=0.039,95%CI:0.005-0.323,P=0.003)and cardiopulmonary bypass time(CBPT)(OR=1.016,95%CI:1.000-1.031,P=0.044)were the risk factors of REPE after thoracoscopic cardiac surgery(P<0.05).The rate of re-intubation,duration of ventilator use and mortality in NREPE group were lower than those in REPE group(P<0.05).Conclusion The incidence of REPE after thoracoscopic cardiac surgery is higher during the perioperative period,and the use time of ventilator is obviously prolonged.The mortality of REPE group is higher than that of NREPE group.BMI,diabetes and CBPT are the risk factors of NREPE after thoracoscopic cardiac surgery.

关 键 词：胸腔镜 心脏手术 低氧血症 复张性肺水肿 

分 类 号：R614.2[医药卫生—麻醉学] R655[医药卫生—外科学]