冠状动脉旁路移植术延迟气管导管拔管的影响因素分析  

Influencing factors of delayed tracheal extubation for coronary artery bypass grafting

作　　者：张倩倩 于欢 范永娟 刘志刚[3] 王伟[2] Zhang Qianqian;Yu Huan;Fan Yongjuan;Liu Zhigang;Wang Wei(Graduate School,Chengde Medical University,Chengde 067000,China;The ICU of Teda International Cardiovascular Hospital,Tian-jin 300457,China;Department of Cardiac Surgery,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]承德医学院研究生学院,承德067000 [2]泰达国际心血管病医院ICU,天津300457 [3]泰达国际心血管病医院心外科,天津300457

出　　处：《国际麻醉学与复苏杂志》2024年第4期354-360,共7页International Journal of Anesthesiology and Resuscitation

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-019A)。

摘　　要：目的探讨快通道麻醉(FTA)冠状动脉旁路移植术(CABG)术后延迟气管导管拔管的危险因素。方法回顾收集2021年11月—2022年11月CABG患者404例,根据术后气管导管拔管时间分为正常拔管组(≤6 h,216例)和延迟拔管组(>6 h,188例)。比较两组患者基线资料、手术资料及预后差异,采用多因素logistic回归分析延迟气管导管拔管的独立危险因素,建立风险预测模型,以受试者操作特征(ROC)曲线获取最佳截断值,以曲线下面积(AUC)评价模型的预测效能。结果与正常拔管组比较,延迟拔管组患者年龄较大,女性比例、纽约心脏病协会(NYHA)心功能分级≥Ⅲ级比例较高,欧洲心脏手术危险评估系统(EuroSCORE)评分和冠状动脉造影冠心病心脏外科与介入治疗狭窄冠状动脉研究(SYNTAX)评分较高(均P<0.05);手术时间、体外循环(CPB)时间、主动脉阻断时间较长,术中乳酸(Lac)较高,术中血制品输注例数、寒战例数、围手术期使用主动脉内球囊反搏(IABP)例数较多(均P<0.05);二次插管率高,ICU住院时间及总住院时间长,气胸、肺不张及胸腔积液的发生率较高(均P<0.05)。其余指标两组差异无统计学意义(均P>0.05)。多因素logistic回归显示女性[比值比(OR)2.391,95%置信区间(CI)1.430~3.999,P=0.001]、EuroSCORE评分高(OR 1.312,95%CI 1.172~1.469,P<0.001)、冠状动脉造影SYNTAX评分高(OR 1.056,95%CI 1.018~1.095,P=0.004)、手术时间长(OR 1.004,95%CI 1.001~1.008,P=0.014)、主动脉阻断时间长(OR 1.011,95%CI 1.001~1.022,P=0.038)、围手术期使用IABP(OR 9.978,95%CI 3.832~25.980,P<0.001)、寒战(OR 2.076,95%CI 3.832~25.980,P=0.012)是FTA下CABG术后延迟气管导管拔管的独立危险因素。EuroSCORE评分、冠状动脉造影SYNTAX评分、手术时间、主动脉阻断时间的最佳截断值分别为5.5分、29.5分、297.5 min和97.5 min。联合预测因子的AUC为0.839,敏感度0.713,特异度0.819。结论女性、EuroSCORE评分高、冠状动脉造影SYNObjective To investigate the risk factors of delayed tracheal extubation after fast-track anesthesia(FTA)for coronary artery bypass grafting(CABG).Methods A total of 404 patients with CABG who were admitted from November 2021 to November 2022 were retrospectively selected.According to the time of postoperative tracheal extubation,they were divided into two groups:a normal extubation group(≤6 h,n=216)and a delayed extubation group(>6 h,n=188).Both groups were compared for baseline data,surgical data and prognosis.Multivariate logistic regression was performed to analyze the independent risk factors of delayed tracheal extubation.A risk prediction model was established,and the optimal cut-off values were obtained based on receiver operating characteristic curve(ROC).The area under curve(AUC)was calculated to evaluate the prediction efficiency of the model.Results The delayed extubation group had older ages,and more female patients,with a higher percentage of patients with New York Heart Association(NYHA)cardiac function grade≥Ⅲ,and higher European System for Cardiac Operative Risk Evaluation(EuroSCORE)and Synergy between PCI with TAXUS and Cardiac Surgery(SYNTAX)scores than the normal extubation group(all P<0.05).Compared with the normal extubation group,the delayed extubation group also showed increases in operation time,cardiopulmonary bypass(CPB)time and aortic occlusion time,intraoperative lactic acid(Lac),as well as the number of cases of intraoperative blood product infusion,shivering and perioperative intra-aortic balloon pump(IABP)(all P<0.05);and increases in the secondary intubation rate,the length of intensive care unit(ICU)stay,the total length of hospitalization stay,and the incidences of pneumothorax,atelectasis and pleural effusion(all P<0.05).There was no statistical difference in other indexes between the two groups(all P>0.05).According to multivariate logistic regression,female[odds ratio(OR)2.391(95%confidence interval(CI)1.430,3.999),P=0.001],high EuroSCORE score[OR 1.312,(95%CI 1.172,1.4

关 键 词：冠状动脉旁路移植术 快通道麻醉 体外循环 机械通气 延迟拔管 危险因素 

分 类 号：R65[医药卫生—外科学]