中心静脉—动脉血二氧化碳分压差与成人心脏术后患者呼吸机时间延长的相关性研究  

Study on correlation between central venous-arterial carbon dioxide difference and prolonged mechanical ventilation duration in adult patients after cardiac surgery

作　　者：王姣姣 何海林 古晓林 鲍荣幸 Wang Jiaojiao;He Hailin;Gu Xiaolin;Bao Rongxing(Department of Cardiac Surgical Intensive Care Unit,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Affiliated to Southern Medical University,Guangzhou,Guangdong 510080,China.)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)、广东省心血管研究所心外重症监护二科,广东广州510080

出　　处：《齐齐哈尔医学院学报》2024年第18期1791-1796,共6页Journal of Qiqihar Medical University

摘　　要：目的探究中心静脉—动脉血二氧化碳分压差(Pv-aCO_(2))与心脏外科手术术后呼吸机时间延长的相关性。方法回顾性分析2019年1—6月在本院进行体外循环下心脏外科手术患者的临床资料。以Pv-aCO_(2)的三分位进行分组,通过单因素和多因素logistic回归模型结合限制性立方样条模型分析Pv-aCO_(2)与术后呼吸机时间延长的相关性及反应曲线关系。绘制受试者工作特征曲线分析Pv-aCO_(2)对术后呼吸机时间延长发生的预测价值。结果研究共纳入455例患者,有112例(24.6%)患者发生术后呼吸机时间延长,在校正多种因素的影响后,限制性立方样条分析提示Pv-aCO_(2)与术后呼吸机时间延长发生呈现线性关系(非线性检验P=0.073)。多因素logistic回归分析提示,发生呼吸机时间延长的风险,以低值组患者为参照,中值组患者是1.27倍(OR=1.27,95%CI 0.65~2.48,P=0.487),高值组患者是2.58倍(OR=2.58,95%CI 1.23~5.43,P=0.012)。Pv-aCO_(2)水平越高的分组,术后发生呼吸机时间延长的风险越高(趋势性检验P=0.007)。Pv-aCO_(2)预测术后呼吸机时间延长的受试者工作特征曲线分析显示,曲线下面积0.585,95%CI 0.522~0.647,P=0.003。结论Pv-aCO_(2)是心脏外科手术术后呼吸机时间延长的独立危险因素,且对其发生具有较好的预测价值。Objective To explore the correlation between central venous-arterial carbon dioxide difference(Pv-aCO_(2))and prolonged mechanical ventilation following cardiac surgery.Methods A retrospective analysis was conducted on clinical data of patients undergoing cardiac surgery with cardiopulmonary bypass in the department of cardiac intensive care unit at a certain hospital from January 2019 to June 2019.Patients were grouped based on the tertiles of Pv-aCO_(2).The correlation and dose-response relationship between Pv-aCO_(2)and prolonged mechanical ventilation were analyzed using univariate and multivariate logistic regression models combined with restricted cubic spline models.Receiver operating characteristic curves were plotted to assess the predictive value of Pv-aCO_(2)for prolonged mechanical ventilation.Results A total of 455 patients were included in the study,of whom 112 patients(24.6%)experienced prolonged mechanical ventilation.After adjusting for multiple factors,the restricted cubic spline analysis indicated a linear relationship between Pv-aCO_(2)and prolonged mechanical ventilation occurrence(nonlinear test P=0.073).Multivariate logistic regression analysis demonstrated that compared to the low Pv-aCO_(2)group,the middle Pv-aCO_(2)group had 1.27 times the risk(OR=1.27,95%CI 0.65-2.48,P=0.487),and the high Pv-aCO_(2)group had 2.58 times the risk(OR=2.58,95%CI 1.23-5.43,P=0.012)of experiencing prolonged mechanical ventilation.A higher level of Pv-aCO_(2)was associated with an increased risk of prolonged mechanical ventilation(trend test P=0.007).The receiver operating characteristic curve analysis for Pv-aCO_(2)predicting prolonged mechanical ventilation showed an area under the curve of 0.585,95%CI 0.522-0.647,P=0.003.Conclusions Pv-aCO_(2)is an independent risk factor for prolonged mechanical ventilation after cardiac surgery and demonstrates a good predictive value for its occurrence.

关 键 词：中心静脉—动脉血二氧化碳分压差 成人患者 心脏外科手术 呼吸机时间 

分 类 号：R654.2[医药卫生—外科学]