中国现代医学杂志2017，Vol.27Issue(28)：91-95,5.DOI:10.3969/j.issn.1005-8982.2017.28.018
单纯瓣膜置换术后机械通气时间延长的危险因素分析以及对临床预后的影响
Risk factors for prolonged mechanical ventilation after isolated heart valve replacement and its effect on clinical prognosis
徐先增 1刘阳春 1钱靖 1周婷 1谢晓勇 1雷宾峰 1冯旭 1郑宝石1
作者信息
- 1. 广西医科大学第一附属医院 心胸外科,广西 南宁 530021
- 折叠
摘要
Abstract
Objective To investigate the incidence and risk factors of prolonged mechanical ventilation (pMV) in patients undergoing isolated heart valve prosthesis implantation (hVpI) and its influence on patients' prognosis. Methods Totally 400 patients who underwent hVpI in the Department of Cardiothoracic Surgery of our hospital in 2013 were analyzed retrospectively. preoperative, intraoperative and postoperative variables were analyzed as risk factors. pMV was defined as time of postoperative ventilation >24 hours. Results There were 87 patients (21.8%) who matched the diagnosis criterion of pMV. Univariate analysis showed that preoperative total bilirubin, heart function in grade III-IV, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), cardiopulmonary bypass time, postoperative drainage volume, hemoglobin, serum creatinine, glucose and lactate (within 24 hours after hVpI) were significantly different between the non-pMV group (group A) and the pMV group (group B, all P < 0.05). Multivariate analysis showed that LVEF >50% (Ol^R = 0.051, 95% CI: 0.005-0.541;P = 0.014) was an independent protective factor for postoperative pMV, but cardiopulmonary bypass time >120 min (Ol^R = 2.144, 95% CI: 1.061-4.335; P = 0.034), postoperative creatinine >133 mol/L (Ol^R = 2.979, 95% CI: 1.463-6.069; P = 0.003) and lactic acid >5 mmol/L (Ol^R = 4.379, 95% CI: 2.115-9.067; P = 0.000) were the independent risk factors for pMV after hVpI surgery. The pMV group had significantly increased risks of postoperative mortality (Ol^R = 8.0, 95% CI: 1.4-44.3; P = 0.019) and ICU stay time >2 days (Ol^R = 9.4, 95% CI: 5.4-16.3; P = 0.000) compared with the control group. Conclusions Left ventricular systolic function, cardiopulmonary bypass time, postoperative level of creatinine and lactic acid are separately associated with pMV after hVpI. pMV can lead to increased postoperative mortality and prolonged ICU stay time.关键词
心脏瓣膜置换术/机械通气/危险因素/预后Key words
heart valve replacement surgery/mechanical ventilation/risk factor/prognosis分类
医药卫生引用本文复制引用
徐先增,刘阳春,钱靖,周婷,谢晓勇,雷宾峰,冯旭,郑宝石..单纯瓣膜置换术后机械通气时间延长的危险因素分析以及对临床预后的影响[J].中国现代医学杂志,2017,27(28):91-95,5.
