摘要
目的探讨瓣膜手术后发生呼吸功能衰竭的危险因素。方法将2005年1月1日至5月31日间完成的507例瓣膜手术病人,按术后有无呼吸功能衰竭分为两组,进行单因素分析和多因素Lo-gistic回归分析。呼吸衰竭定义为术后机械通气48h以上或全麻拔管6h后再次插管行机械通气。结果发生术后呼吸功能衰竭31例(6·1%)。单因素分析发现术前年龄、心脏手术史、心功能分级、合并冠状动脉粥样硬化性心脏病、心胸比率、呼吸功能、血浆白蛋白浓度,术中合并冠状动脉旁路移植术、体外循环时间、主动脉阻断时间、二次体外循环支持,术后氧合指数与术后发生呼吸功能衰竭有关。经多因素Logistic回归分析发现,年龄≥65岁、术前最大通气量显著减退、术中二次体外循环支持、术后ICU第2h血气氧合指数低于300mmHg,为瓣膜手术后发生呼吸功能衰竭的危险因素。结论临床上可根据年龄、最大通气量、术中是否二次体外循环支持、术后氧合指数预测术后呼吸功能衰竭,并可预先采取措施预防,以减少呼吸功能衰竭的发生。
Objective To analyze risk factors associated with postoperative respiratory failure（PRF） after valvular surgery. Methods Between January 2005 and May 2005, 507 patients undergoing valvular surgery were examined retrospectively. Multiple perioperative factors were evaluated by univariate and multivariate logistic regression analysis. PRF was defined as mechanical ventilation lasting for more than 48 hours after operation or reintubation and mechanical ventilation 6 hours later after extubation. Results Thirty-one patients（6.1%） developed PRF. Univariate risk factors included age（ P 〈 0.001）, history of cardiac surgery（ P = 0.005）, NYHA functional class Ⅲ or Ⅳ（ P = 0. 020）, C/T（ P 〈 0. 001 ）, valvular disease with coronary artery disease（ P = 0.016）, preoperative pulmonary dysfunction（ P 〈 0.05）, plasma albumin 〈 35 g/L（ P = 0.010）, combined with coronary artery bypass grafting（ P = 0.038）, cardiopulmonary（CPB） time（ P = 0.001）, aortic cross-clamping time（ P 〈 0.001）, secondary CPB suppert （P = 0.（301）, low ratio of arterial oxygen tension to inspired oxygen fraction （PaO2/FiO2） at ICU 2 h postoperatively（ P 〈 0. 001 ）. Multivariate logistic regression analysis identified that age ≥ 65 years（ odds ratio 6. 250）, preoperative maximal voluntary ventilation（MVV） practical/predictive% 〈 71% （odds ratio 26. 316）, secondary CPB support （odds ratio 4.425）, the second hour PaO2/FiO2 〈 300 mm Hg （odds ratio 90.909） at ICU were risk factors. Conclusion The results of this study suggest that patients with risk factors described above need more careful peri- and post- operative surveillance and management.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2006年第4期217-219,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏瓣膜
手术后并发症
呼吸功能不全
危险因素
Heart valves Respiratory insufficiency Postoperative complications Risk factors
