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

发布时间：2018-05-10 06:14

  本文选题：心脏瓣膜置换术 + 机械通气　； 参考：《中国现代医学杂志》2017年28期

【摘要】：目的探究单纯瓣膜置换(HVPI)术后机械通气时间延长(PMV)的发生率、危险因素以及对临床预后的影响。方法回顾性分析该院心胸外科2013年度的HVPI的400例患者。记录术前、术中以及术后等多种变量,进行单因素和多因素分析。呼吸机时间延长定义为术后呼吸机应用时间24 h。结果 PMV患者87例(21.8%)。单因素分析发现非PMV组(A组)与PMV组(B组)患者在总胆红素水平、心功能Ⅲ~Ⅳ级、左室舒张末径、左室射血分数、转机时间、手术当天引流量、血红蛋白、血清肌酐、血糖、乳酸等方面,差异有统计学意义(P0.05)。多因素分析发现LVEF50%(OR=0.051,95%CI:0.005~0.541,P=0.014)是避免术后PMV的保护因素,而转机时间120 min(OR=2.144,95%CI:1.061~4.335,P=0.034)、术后24 h肌酐133μmol/L(OR=2.979,95%CI:1.463~6.069,P=0.003)和乳酸5 mmol/L(OR=4.379,95%CI:2.115~9.067,P=0.000)是导致术后PMV的危险因素。术后PMV患者组患者术后死亡率(OR=8.0,95%CI:1.4~44.3,P=0.019)和ICU2 d(OR=9.4,95%CI:5.4~16.3,P=0.000)的风险较对照组增加。结论 HVPI术后PMV与左心收缩功能、转机时间、术后早期肌酐和乳酸水平等多因素相关,PMV可导致术后死亡率增加和ICU滞留时间延长。
[Abstract]:Objective to investigate the incidence, risk factors and clinical prognosis of prolonged mechanical ventilation (PMV) after simple valve replacement (HVPI). Methods A retrospective analysis of 400 patients with HVPI in the Department of Cardiothoracic surgery in 2013 was performed. All variables were recorded before, during and after operation, and univariate and multivariate analysis were performed. The extension of ventilator time was defined as 24 hours after operation. Results 87 patients with PMV were involved in 21. 8 cases. Univariate analysis showed that the total bilirubin level, cardiac function 鈪，

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