高龄患者冠状动脉旁路移植术后通气时间延长的危险因素和围术期结果分析  

Risk factors and perioperative outcomes of prolonged mechanical ventilation after coronary artery bypass grafting in elderly patients

作　　者：王梧圩 张航 陈文[2] 李良鹏[2] 陈鑫 WANG Wuwei;ZHANG Hang;CHEN Wen;LI Liangpeng;CHEN Xin(School of Medicine,Southeast University,Nanjing,210009,P.R.China;Department of Cardiovascular Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing First Hospital,Nanjing Cardiovascular Hospital,Nanjing,210006,P.R.China;Department of Thoracic Surgery,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,201620,P.R.China)

机构地区：[1]东南大学医学院,南京210009 [2]南京医科大学附属南京医院南京市第一医院南京市心血管病医院心胸血管外科,南京210006 [3]上海交通大学医学院附属第一人民医院胸外科,上海201620

出　　处：《中国胸心血管外科临床杂志》2023年第7期995-1001,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的研究高龄患者行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后通气时间延长(prolonged mechanical ventilation,PMV)的危险因素和围术期结果。方法回顾性分析2013年1月—2019年6月在南京市第一医院行CABG高龄冠心病患者的临床资料。以呼吸机辅助时间是否≥24 h,将纳入患者分为正常拔管组和PMV组,比较两组患者围术期的临床特征,寻找PMV的危险因素。采用1∶1倾向性评分匹配分析(propensity score matching,PSM)平衡组间基线资料差异,分析两组患者围术期结果。结果最终纳入患者956例,其中男586例、女370例,年龄70~94(74.3±3.5)岁。PMV组187例、正常拔管组769例。与正常拔管组相比,PMV组吸烟史、术前合并肾功能损伤、术中输血、主动脉内球囊反搏(intra-aortic balloon pump,IABP)置入患者比例更高,心功能更差,肾小球滤过率和射血分数更低,左心房内径更大,体外循环时间和升主动脉阻断时间更长(P均<0.05)。两组患者其余临床资料差异无统计学意义(P均>0.05)。二元多因素logistic回归分析示:女性、吸烟史、慢性阻塞性肺疾病、左心室射血分数≤56.0%、体外循环时间>106.0 min、IABP置入和术中输血是高龄患者PMV的独立危险因素。PSM后正常拔管组和PMV组各146例,PMV组患者的住ICU时间和住院时间更长,胸腔引流量更多(P均<0.05)。两组围术期死亡和其他并发症发生率差异无统计学意义(P均>0.05)。结论影响高龄患者CABG术后PMV的危险因素众多,临床医师可在此研究基础上,进一步对术前、术中相关因素做精细评估,以期建立更加完整、规范的PMV预测模型,改善此类患者围术期结果。Objective To investigate the clinical characteristics,risk factors and perioperative outcome of prolonged mechanical ventilation(PMV)in elderly patients undergoing coronary artery bypass grafting(CABG).Methods The data of elderly patients receiving CABG in the Nanjing First Hospital from January 2013 to June 2019 were collected.All patients were divided into a control group and a PMV group according to whether ventilation time≥24 h.The clinical characteristics and risk factors of PMV were compared between the two groups.Variables were 1∶1 balanced through propensity score matching(PSM)and perioperative outcomes of two groups was analyzed.Results Finally 956 patients were collected,including 187 in the PMV group and 769 in the control group.There were 586 males and 370 females aged 70-94(74.3±3.5)years.Compared with the control group,the PMV group had higher rates of smoking,preoperative renal impairment,intraoperative blood transfusion and intra-aortic balloon pump(IABP)implantation,worse cardiac function,lower glomerular filtration rate and ejection fraction,larger left atrial diameter,longer cardiopulmonary bypass time and aortic cross-clamping time(P<0.05).There was no statistical difference in other clinical data between the two groups(P>0.05).Binary multivariate logistic regression analysis showed that females,smoking,chronic obstructive pulmonary disease,left ventricular ejection fraction≤56.0%,cardiopulmonary bypass time>106.0 min,IABP implantation and intraoperative blood transfusion were independent risk factors for PMV in elderly patients.After PSM,there were 146 patients in the control group and the PMV group,respectively.The PMV group had longer ICU stay and length of hospital stay and more drainage volume compared with the control group(all P<0.05).There was no statistical difference in perioperative mortality or other complications between the two groups(all P>0.05).Conclusion There are a lot of factors associated with PMV of the elderly patients undergoing on-pump CABG.In order to establish

关 键 词：高龄患者 冠状动脉旁路移植术 机械通气 拔管 危险因素 

分 类 号：R654.2[医药卫生—外科学]