成人体外循环下心血管术后重度低氧血症现状及影响因素分析  

Risk factors of postoperative severe hypoxemia after cardiovascular surgery with cardiopulmonary bypass in adults

作　　者：张林浩[1] 向玉萍 罗天会[1] 曾玲[1] ZHANG linhao;XIANG Yuping;LUO Tianhui;ZENG Ling(Department of Intensive Care Unit/School Nursing of West China,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院重症医学科胸心血管ICU,610041

出　　处：《临床外科杂志》2024年第8期822-825,共4页Journal of Clinical Surgery

摘　　要：目的探讨成人体外循环下心血管术后重度低氧血症的危险因素。方法2021年1月~2021年12月成人体外循环下心血管术后病人395例。采用电子病历系统收集病人社会人口学资料、疾病相关资料、术前检验结果、术中资料、术后6小时内检验指标及术后72小时内氧合指数;氧合指数≤100 mmHg为重度低氧血症组(20例),氧合指数>100 mmHg为非重度低氧血症组(375例),比较两组病人的围术期临床资料。多因素logistic回归分析成人体外循环下心血管术后重度低氧血症的危险因素。结果395例病人术后重度低氧血症发生率为5.06%(20/395),多因素logistic回归分析显示,体质量指数(BMI,OR=3.713,95%CI 1.946~7.083,P<0.001),术前中性粒细胞计数(OR=1.164,95%CI 1.034~1.312,P<0.012),主动脉阻断时间(OR=1.009,95%CI 1.001~1.018,P=0.030)是成人体外循环下心血管术后重度低氧血症的独立危险因素。术后重度低氧血症组有创通气时间、ICU住院时间、总住院时间延长,再次气管插管率更高(P<0.05)。结论BMI、术前中性粒细胞计数、主动脉阻断时间是成人体外循环下心血管术后重度低氧血症的独立危险因素,术后重度低氧血症病人预后更差。Objective To investigate the risk factors of severe hypoxemia after cardiovascular surgery with cardiopulmonary bypass in adults.Methods Retrospective analysis of clinical data of 395 adult patients after cardiovascular surgery with cardiopulmonary bypass from January 2021 to December 2021.The general socio-demographic data,disease-related data,preoperative test results,intraoperative data,test indexes within 6 hours after surgery and oxygenation index within 72 hours after surgery were collected using an electronic case system;patients with postoperative oxygenation index≤100 mmHg was defined as severe hypoxemia group(20 cases),oxygenation index>100 mmHg was defined as non-hypoxemia group(375 cases),compared the perioperative clinical data of two groups,and explored the risk factors for severe hypoxemia by multifactorial logistic review.Results A total of 395 patients were included,and the incidence of postoperative severe hypoxemia was 5.06%(20/395).Multifactorial logistic retrospective analysis showed that body mass index(OR=3.713,95%CI 1.946~7.083,P<0.001),preoperative neutrophil count(OR=1.164,95%CI 1.034~1.312,P<0.012),and aortic clamping time(OR=1.009,95%CI 1.001~1.018,P=0.030)were independent risk factors for postoperative severe hypoxemia.In addition,the duration of invasive ventilation,ICU stay,and total hospital days were prolonged and the incidence of reintubation was higher in the severe hypoxemia group(P<0.05).Conclusion The results howed that body mass index,preoperative neutrophils count,and aortic clamping time were independent risk factors for postoperative severe hypoxemia after cardiovascular surgery with cardiopulmonary bypass,and patients with severe hypoxemia had a worse prognosis.

关 键 词：体外循环 心血管手术 重度低氧血症 危险因素 

分 类 号：R654.1[医药卫生—外科学]