心内直视手术后呼吸衰竭的危险因素分析及对策探讨

目的:分析心内直视手术后发生呼吸衰竭的危险因素及其防治方法。方法:回顾分析2000年1月-2003年8月心内直视手术后发生呼吸衰竭32例成人患者的一般临床资料,以及是否存在合并症等资料;同时记录彩色多普勒超声心动图结果,术中心肌保护方式,转流时间,术前、术后的心肌酶谱,术后的血气分析结果,呼吸机功能参数,引流量,是否发生严重并发症和预后等临床资料,与同期心内直视手术术后呼吸机辅助支持不超过48h的患者中随机抽取32例进行原因分析和比较。结果:术后呼吸机辅助呼吸时间与患者术前心功能差、术中转流时间长、术中心肌保护不良、术后低氧血症以及发生心、肺、脑、多器官功能衰竭,术后引流多等6个因素是心内直视手术后呼吸衰竭的危险因素。结论:术前心、肺功能准备充分,尽可能缩短体外循环时间和主动脉阻断时间,预防和治疗心、肺、脑等重要器官并发症及合理应用呼吸机治疗,严密止血,列促进患者早日康复有重要意义。

Risk Factors and Strategies for Respiratory Failure after Cardiac Surgery

Objective: To analyze the risk factors and prevention and cure of respiratory failure after cardiac surgery. Methods: The clinical data of 32 patients with respiratory failure after cardiac surgery, including general clinical data, postoperative complications, the results of color Doppler ultrasonography, the way of cardiac muscular protection, the time of CPB, cardiac muscular enzymes before and after operation, arterial gas analysis, the parameters of respirator, the volume of drainage and prognosis were Analyzed retrospectively . Meanwhile, in order to analyze the causes of RF, we compared the data with those of another group of 32 patients chosen at random as the contrast who underwent less than 48 hours' assisting-respiration with respirator after cardiac surgery. Results: According to our investigation, the following 6 factors were the nsk factors of respiratory failure after cardiac surgery, which were the time of postoperative assisting-respira-tion with respirator, the time of CPB, insufficient cardiac muscular protection, postoperative hypoxia, MODS and excessive volume drainage. Conclusion:Full preparation of the cardiac and pulmonary function, shortening the time of CPB and blocking aorta, prevention and cure the complications of vital organs such as heart, lung and brain, properly using respirator and reducing bleeding during operation are all of great importance for recovery of the patients.