左冠状动脉起源于肺动脉患儿术后延迟拔管危险因素分析

发布时间：2018-06-29 01:16

本文选题：左冠状动脉起源于肺动脉 + 延迟拔管　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:左冠状动脉起源于肺动脉(ALCAPA)患儿术后常发生延迟拔管,导致患儿重症监护室(ICU)停留时间延长,呼吸机相关并发症发生率增加和住院费用增加。目前尚缺乏对ALCAPA术后延迟拔管的危险因素进行分析的相关文献,因此本篇文章目的是研究ALCAPA术后延迟拔管的发生率及危险因素。方法:回顾性分析阜外医院2010年7月至2016年5月在体外循环下行ALCAPA矫治术患儿的临床资料,排除合并法洛四联症、右室双出口和其他冠状动脉畸形患儿,同时排除行结扎术同期行冠脉搭桥术和内隧道手术患儿,最终76例患儿入选。按机械通气时间是否长于24h将患儿分为延迟拔管组(34例)和非延迟拔管组(42例),对比分析两组患儿术前、术中及术后各项变量,寻找影响延迟拔管的单因素变量,再将有统计学意义的单因素变量纳入Logistic回归分析中寻找延迟拔管的独立危险因素,并根据ROC曲线下面积,确定预测延迟拔管的阳性界值(cut-off值)。结果:76例患儿中,2例死亡,8例延迟关胸,3例术后使用ECMO辅助,5例拔管后发生再次插管。34例(44.7%)患儿机械通气时间超过24小时,机械通气中位数时间为19(9.3,67.5)小时,年龄中位数为12(7.2,60)个月,男性稍占优势(53.9%),而且延迟拔管患儿ICU停留时间和住院时间均延长。延迟拔管的单因素变量有年龄、体重、ASA分级、术前左室射血分数、术前贫血、术前白蛋白、术前肌酐、术前乳酸脱氢酶、术前肌酸同工酶、术中正性肌力药评分最大值、术后肌酸同工酶、术后乳酸脱氢酶及术后左房压(P0.05)。经Logistic回归分析和ROC曲线下面积分析得出,延迟拔管的独立危险因素是体重(OR=0.52,95%CI:0.31～0.87)和术前EF值(OR=0.94,95%CI:0.89～0.99),它们的阳性界值分别为:10.5kg、32.5%(敏感性分别为:71.4%,95.2%;特异性分别为:94.1%,67.6%)。结论:ALCAPA患儿术后易发生延迟拔管,延迟拔管患儿ICU停留时间和住院时间均延长。本研究显示:体重和术前EF值是ALCAPA患儿延迟拔管的独立危险因素。
[Abstract]:Objective: delayed extubation of left coronary artery originated from pulmonary artery (ALCAPA) resulted in prolonged stay in intensive care unit (ICU), increased incidence of ventilator-associated complications and increased hospitalization costs. There is a lack of relevant literature to analyze the risk factors of delayed extubation after ALCAPA, so the purpose of this article is to study the incidence and risk factors of delayed extubation after ALCAPA. Methods: the clinical data of children undergoing ALCAPA correction under cardiopulmonary bypass in Fuwei Hospital from July 2010 to May 2016 were retrospectively analyzed to exclude children with tetralogy of Fallot, double outlet right ventricle and other coronary artery malformations. At the same time, 76 children were included in coronary artery bypass grafting and internal tunnel operation. Children were divided into delayed extubation group (34 cases) and non delayed extubation group (42 cases) according to whether the mechanical ventilation time was longer than 24 h. The single variable with statistical significance was incorporated into Logistic regression analysis to find out the independent risk factors of delayed extubation, and the positive threshold value (cut-off value) of delayed extubation was determined according to the area under the ROC curve. Results among 76 children, 2 cases died and 8 cases delayed closure of chest. 3 cases were treated with ECMO after extubation. 34 cases (44.7%) had mechanical ventilation more than 24 hours, the median time of mechanical ventilation was 19 (9.3 卤67.5) hours. The median age was 12 months (7.2 卤60 months), male was a little dominant (53.9%), and the ICU stay time and hospitalization time were prolonged in children with delayed extubation. Univariate variables of delayed extubation included age, weight and ASA grade, left ventricular ejection fraction (LVEF), preoperative anemia, preoperative albumin, preoperative creatinine, preoperative lactate dehydrogenase, preoperative creatine isozyme, maximum intraoperative positive creatine score. Postoperative creatine isoenzyme, lactate dehydrogenase and left atrial pressure (P0.05). Logistic regression analysis and area analysis under the ROC curve showed that the independent risk factors for delayed extubation were weight (ORO 0.5295 CI: 0.31 / 0.87) and preoperative EF value (ORG 0.94 ~ 95CI: 0.89: 0.99). Their positive threshold values were 10.5kg / kg ~ 32.5% (sensitivity: 71.4kg / 95.2respectively) and specificity = 0.94.17.6%, respectively. Conclusion delayed extubation is easy to occur in children with different levels of propofol. The ICU stay time and hospitalization time of children with delayed extubation are prolonged. Weight and preoperative EF were independent risk factors for delayed extubation in children with ALCAPA.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.1

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