肺动脉血栓内膜剥脱术后机械通气时间延长的术前危险因素分析  

Analysis of preoperative risk factors for prolonged mechanical ventilation after pulmonary thromboendarterectomy

作　　者：王晓晖 刘展[1,2] 张昭华 甄雅南 林凡[2] 郑夏[2] 刘晓鹏[2] 孙光 温见燕[1,2] 叶志东 刘鹏[1,2] WANG Xiaohui;LIU Zhan;ZHANG Zhaohua;ZHEN Yanan;LIN Fan;ZHENG Xia;LIU Xiaopeng;SUN Guang;WEN Jianyan;YE Zhidong;LIU Peng(Peking University China-Japan Friendship School of Clinical Medicine,Beijing,100029,P.R.China;Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing,100029,P.R.China)

机构地区：[1]北京大学中日友好临床医学院,北京100029 [2]中日友好医院心脏血管外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2023年第10期1452-1457,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82170066,81670443,81670275)。

摘　　要：目的分析肺动脉血栓内膜剥脱术(pulmonary thromboendarterectomy,PTE)后机械通气时间延长的危险因素。方法回顾性分析中日友好医院2016年12月—2021年8月行PTE患者的临床资料。按术后机械通气时间,将患者分为机械通气时间≤48 h组与机械通气时间>48 h(机械通气时间延长)组。采用单因素及二元logistic回归分析影响患者术后机械通气时间延长的术前危险因素。结果共纳入90例患者,机械通气时间≤48 h组40例,其中男30例、女10例,平均年龄(45.48±12.72)岁;机械通气时间>48 h组50例,其中男29例、女21例,平均年龄(55.50±10.42)岁。机械通气时间≤48 h组术后中位ICU停留时间3.0 d,术后中位住院时间15.0 d;机械通气时间>48 h组术后中位ICU停留时间7.0 d,术后中位住院时间20.0 d。术后机械通气时间延长与三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)[OR=0.839,95%CI(0.716,0.983),P=0.030]、年龄[OR=1.082,95%CI(1.034,1.132),P=0.001]、肺血管阻力(pulmonary vascular resistance,PVR)[OR=1.001,95%CI(1.000,1.003),P=0.028]有显著相关性。结论年龄及PVR是PTE术后机械通气时间延长的术前危险因素;TAPSE是PTE术后机械通气时间延长的术前保护因素。Objective To identify the preoperative risk factors for prolonged mechanical ventilation(PMV)after pulmonary thromboendarterectomy(PTE).Methods The clinical data of patients who underwent PTE from December 2016 to August 2021 in our hospital were retrospectively analyzed.The patients were divided into two groups according to the postoperative mechanical ventilation time,including a postoperative mechanical ventilation time≤48 h group(≤48 h group)and a postoperative mechanical ventilation time>48 h(PMV)group(>48 h group).Univariable and logistic regression analysis were used to identify the preoperative risk factors for postoperative PMV.Results Totally,90 patients were enrolled in this study.There were 40 patients in the≤48 h group,including 30 males and 10 females,with a mean age of 45.48±12.72 years,and there were 50 patients in the>48 h group,including 29 males and 21 females,with a mean age of 55.50±10.42 years.The results showed that in the≤48 h group,the median postoperative ICU stay was 3.0 days,and the median postoperative hospital stay was 15.0 days;in the>48 h group,the median postoperative ICU stay was 7.0 days,and the median postoperative hospital stay was 20.0 days.The postoperative PMV was significantly correlated with tricuspid annular plane systolic excursion(TAPSE)[OR=0.839,95%CI(0.716,0.983),P=0.030],age[OR=1.082,95%CI(1.034,1.132),P=0.001]and pulmonary vascular resistance(PVR)[OR=1.001,95%CI(1.000,1.003),P=0.028].Conclusion Age and PVR are the preoperative risk factors for PMV after PTE,and TAPSE is the preoperative protective factor for PMV after PTE.

关 键 词：肺动脉血栓内膜剥脱术 机械通气 危险因素 

分 类 号：R655.3[医药卫生—外科学]