摘要
目的探讨急性StanfordA型主动脉夹层术后机械通气延长的危险因素。方法回顾性分析2009年5月至2016年5月202例StanfordA型主动脉夹层手术患者资料。机械通气≥48h70例(A组),机械通气<48h132例(B组)。对两组患者围术期多项指标进行单因素和多因素分析。结果两组患者机械通气分别为(146.8±78.5)h和(21.7±9.5)h,院内死亡比例分别为8.6%和2.3%。多因素分析显示,体质量指数(OR=5.956,95%CI:2.585~13.723,P=0.000)、体外循环(OR=1.108,95%CI:1.052~1.166,P=0.000)、深低温停循环(OR=4.562,95%CI:1.250~16.640,P=0.022)和术中及术后24h输注红细胞量(OR=2.625,95%CI:1.515~4.549,P=0.001)是机械通气延长的独立危险因素。结论体质量指数、体外循环、深低温停循环和术中、术后24h输注红细胞量是急性StanfordA型主动脉夹层术后机械通气延长的独立危险因素。临床上可以根据上述危险因素采取相应的预防措施,有助于缩短术后ICU监护时间。
Objective To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours(group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146.8±78.5)h and(21.7±9.5)h in group A and group B respectively. Overall in-hospital mortality was 8.6% and 2.3%. Multivariate logistic analysis showed that BMI(OR=5.956, 95%CI: 2.585-13.723, P=0.000), CPB time(OR=1.108, 95%CI: 1.052-1.166, P=0.000), DHCA(OR=4.562, 95%CI: 1.250-16.640, P=0.022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR=2.625, 95%CI: 1.515-4.549, P=0.001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.
作者
生伟
栾天
池一凡
牛兆倬
张文峰
吴建涛
王天毅
李好友
孙龙
Sheng Wei;Luan Tian;Chi Yifan;Niu Zhaozhuo;Zhang Wenfeng;Wu Jiantao;Wang Tianyi;Li Haoyou;Sun Long(Department of Cardiovascular Surgery,Qingdao Municipal Hospital,Medical College of Qingdao University,Qingdao 266071,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2019年第2期72-75,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
青岛市卫计委课题(2014-WJZD030).
关键词
急性主动脉夹层
机械通气延长
危险因素
Acute aortic dissection
Prolonged mechanical ventilation
Risk factors
