婴儿心内直视术后气管插管拔管失败的危险因素

目的　探讨婴儿心内直视术后气管插管拔管失败的危险因素。方法　将 2 0 0 1年 1月至 2 0 0 2年 12月期间在我院行先天性心脏病畸形矫正术后拔管失败、再插管的所有年龄小于 1岁的病例纳入本研究中 ,随机抽取同期拔管成功的所有年龄小于 1岁的病例作为对照组 ,采用Logistic回归模型分析婴儿先心病术后拔管失败的危险因素和独立危险因素 ,用相对危险度OR估计拔管失败与上述因素之间的联系强度。结果　 2 2 7例行心内直视术的婴儿有 30例 (13.2 2 % )发生术后拔管失败 ,Logistic回归单因素分析示导致拔管失败、再插管的危险因素有术后机械通气时间 接触机会比(EOR) =12 .0 ;95 %CI=4 .0 4～ 35 .71;P =0 .0 0 0 9]、术后并发肺炎 (EOR =5 .33;95 %CI =1.81～ 15 .6 8;P =0 .0 0 2 )和术前肺动脉高压 (EOR =2 .80 ;95 %CI =1.2 1～ 10 .4 5 ;P =0 .0 4 1) ,Logistic回归多因素分析示术后肺炎及术前肺动脉高压是拔管失败的独立危险因素 (P <0 .0 5 )。结论　术后肺炎及术前肺动脉高压是婴儿心内直视术后气管插管拔管失败发生的主要相关因素 ,防治肺动脉高压危象、肺炎的发生是提高婴儿心内直视术后气管插管拔管成功率、减少术后死亡率的关键。

The risk factors of failed extubation after cardiac surgery in infants

Objective To investigate the risk factors of failed extubation(FE) after cardiac surgery in infants. Methods 227 infants(< 1 year of age) who underwent congenital heart surgery in the period between January 2001 and December 2002 were included in this study. Logistic regression anaysis was used to assess the risk factors of failed extubation. Odds Ratio was used to suppose the degree of relationship between FE and risk factors. Results Out of the 227 infants undergoing congenital heart operations, 30(13.22%) cases failed at the extubation. Risk factors for failed extubation included postoperative duration of ventilation (EOR=12.0; 95% CI =4.04-35.71; P =0.000 9), postoperative pneumonia (EOR=5.33; 95% CI =1.81-15.68; P =0.002) and preoperative pulmonary hypertension (EOR=2.80; 95% CI =1.21-10.45; P =0.041). Postoperative pneumonia and preoperative pulmonary hypertension were the 2 independent risk factors for failed extubation ( P <0.05). Conclusions Postoperative pneumonia and preoperative pulmonary hypertension are major risk factors for failed extubation after congenital heart surgery in infants. To prevent and to treat postoperative pneumonia and pulmonary hypertensive crises will be beneficial to the successful extubation.