主动脉夹层术后机械通气延迟脱机的影响因素分析  

Analysis of Influencing Factors of Delayed Weaning from Mechanical Ventilation after Aortic Dissection Surgery

作　　者：周旺涛 艾山江·肉孜 通耀威 王睿 任禹澄 袁鑫 宋云林[1] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆 乌鲁木齐 [2]克拉玛依中心医院呼吸与危重症医学科,新疆 克拉玛依

出　　处：《临床医学进展》2024年第6期1111-1119,共9页Advances in Clinical Medicine

摘　　要：目的:探讨主动脉夹层术后机械通气延迟脱机的影响因素。方法:回顾性分析新疆医科大学第一附属医院重症医学科2017年9月至2019年9月期间连续收住的123例主动脉夹层(AD)术后患者的临床资料,其中男104例,女19例,平均年龄46.79 ± 9.16岁,其中DeBakey I型94例,DeBakey II型29例。根据患者术后脱机时间分为两组,机械通气早期脱机组( 0.05)。多因素Logistic回归分析显示,吸烟(OR = 8.023, 95%CI: 1.745~36.883, P = 0.007)、术前白细胞计数(OR = 1.308, 95%CI: 1.024~1.672, P = 0.032)及术后白蛋白水平(OR = 0.791, 95%CI: 0.639~0.978, P = 0.030)是主动脉夹层术后机械通气延迟脱机的独立影响因素。术前白细胞计数预测术后延迟脱机ROC曲线下面积(AUC)为0.712 (95%CI: 0.599~0.825, P = 0.005),最佳截断值为:11.03 × 109/L,敏感度59.4%,特异度76.5%;术后血清白蛋白水平预测术后延迟脱机ROC曲线下面积(AUC)为0.785 (95%CI: 0.683~0.886, P < 0.001),最佳截断值为36.23 g/L,敏感度74.5%,特异度70.6%。术前白细胞计数与术后血清白蛋白水平联合预测ROC曲线下面积(AUC)为0.842 (95%CI: 0.757~0.928, P < 0.001),敏感度68.9%,特异度94.1%。结论:吸烟、术前白细胞计数和术后血清白蛋白水平是主动脉夹层术后机械通气延迟脱机的独立影响因素。术前白细胞计数与术后血清白蛋白水平对主动脉夹层术后机械通气延迟脱机具有一定的预测价值。Objective: To investigate the influencing factors of delayed weaning from mechanical ventilation after aortic dissection surgery. Methods: A total of 123 patients after aortic dissection surgery who were consecutively admitted to the Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from September 2017 to September 2019 were retrospectively analyzed. Of all patients included, 104 were male, 19 were female, and the average age was 46.79 ± 9.16 years old;94 were DeBakey Type I Aortic Dissection, and 29 were DeBakey Type II Aortic Dissection. According to the duration of mechanical ventilation, the patients were divided into early weaning group ( 0.05). Logistic regression showed that smoking (OR = 8.023, 95%CI: 1.745~36.883, P = 0.007), preoperative white blood cell count (OR = 1.308, 95%CI: 1.024~1.672, P = 0.032), and postoperative serum albumin level (OR = 0.791, 95%CI: 0.639~0.978, P 9/L, a sensitivity of 59.4%, and a specificity of 76.5%;postoperative albumin level showed an AUC of 0.785 (95%CI: 0.683~0.886, P < 0.001), an optimal cut-off point of 36.23g/L, a sensitivity of 74.5%, and a specificity of 70.6%;the combination of preoperative white blood cell count and postoperative albumin level showed an AUC of 0.842 (95%CI: 0.757~0.928, P < 0.001), a sensitivity of 68.9%, and a specificity of 94.1%. Conclusions: For delayed weaning from mechanical ventilation after aortic dissection surgery, smoking, preoperative white blood cell count, and postoperative serum albumin level are the independent influencing factors;preoperative white blood cell count and postoperative serum albumin levels for postoperative aortic dissection delayed weaning of mechanical ventilation has certain predictive value.

关 键 词：主动脉夹层 延时脱机 白细胞计数 血清白蛋白 

分 类 号：R47[医药卫生—护理学]