冠脉旁路移植术后患者延迟撤机的危险因素分析

目的 分析影响冠脉旁路移植术后患者延迟撤机的术前、术中及术后早期的危险因素.方法 对2008年1月～2010年12月该院行冠脉旁路移植术后入住重症外科(SICU)患者共152例进行回顾性研究,根据患者机械通气时间分为延迟撤机组(机械通气≥24h)和早期撤机组(机械通气时间＜24 h),对患者术前、术中及术后早期共31项指标作为相关影响因素的分析对象,进行单因素分析,将单因素分析有统计学意义的指标再进行Logistic回归分析.结果 单因素分析提示,心功能(NYHA)分级、体外及非体外循环(ON/OFFPUMP)、主动脉阻断时间、体外循环时间、瓣膜置换、搭桥数目、术中出血量、术中输血总量、术中输液总量、术中出入量平衡、术后血白蛋白及肌酐、术后8h胸液量、术后8h输血量等14项指标在两组间有统计学意义(P＜0.05),进一步行Logistic回归分析表明,NYHA分级(P=0.035,OR=1.5)、体外循环时间(P =0.000,OR=4.53)、搭桥数目(P=0.041,OR=0.683)、术中出血量(P =0.001,OR=2.25)及术后8h胸液量(P =0.005,OR=1.75)5项指标是冠脉旁路移植术后机械通气时间延长的独立影响因素.结论 术前心功能水平、术中体外循环时间、搭桥数目、术中及术后早期的出血量是影响冠脉旁路移植术后呼吸机早期撤离的危险因素.

Analysis of risk factors for delayed weaning in patients after coronary artery bypass grafting

【Objective】 To analysis the preoperative,intraoperative and early postoperative risk factors which led to delayed weaning in patients after coronary artery bypass grafting.【Methods】 152 patients undergoing coronary artery bypass grafting and admitted in SICU of our hospital from January 2008 to December 2010 were analyzed retrospectively.Patients were divided into two groups based on the duration of mechanical ventilation,group I were extubated within 24 h and group II failed extubation within 24 h.31 preoperative,intraoperative and early postoperative factors that may affect weaning were analyzed by Univariate analyses.The factors with significance(P <0.05) were then analyzed with stepwise logistic regression.【Results】 Univariate analyses showed that there was significant difference(P <0.05) between groupⅠand groupⅡin NYHA classes,ON / OFF PUMP,aortic cross clamp(ACC) time,cardiopulmonary bypass(CPB) duration,valve replacement,number of bypass,intraoperative blood loss volume,intraoperative blood transfusion volume,intraoperative liquid transfusion volume,intraoperative access to the amount of balance,postoperative serum albumin and creatinine,drainage fluid volume and blood transfusion volume within 8 hours after operation.Stepwise logistic regression analysis indicated that NYHA classes(P =0.035,OR=1.5),cardiopulmonary bypass(CPB) duration(P =0.000,OR=4.53),number of bypass(P =0.041,OR=0.683),intraoperative blood loss volume(P =0.001,OR=2.25) and drainage fluid volume within 8 hours after operation(P =0.005,OR=1.75) were independent predictors of prolonged mechanical ventilation after coronary artery bypass grafting.【Conclusion】 The preoperative NYHA classes,intraoperative cardiopulmonary bypass(CPB) duration,the number of bypass,intraoperative and early postoperative bleeding volume are major risk factors in postoperative patients with prolonged ventilation mechanical after coronary artery bypass grafting.