婴幼儿体外循环手术后呼吸功能衰竭的危险因素分析

目的探讨婴幼儿体外循环（CPB）手术后呼吸功能衰竭的危险因素。方法将2004年1月至2008年10月间完成的512例先天性心脏病手术患儿,按术后有无呼吸功能衰竭分为两组,进行单因素分析和多因素Logistic回归分析。术后呼吸功能衰竭定义为术后机械通气48 h以上或全麻拔管后6 h再次插管行机械通气。结果术后发生呼吸功能衰竭50例（9.8%）,单因素分析发现术前紫绀型先天性心脏病、重度肺动脉高压、心功能分级、血浆白蛋白浓度、CPB时间、主动脉阻断时间、二次CPB支持、术后氧和指数、术后呼吸机辅助时间、术后并发急性肾功能衰竭与术后发生呼吸功能衰竭有关。经多因素Logistic回归分析发现,CPB时间超过150 m in、二次CPB支持、术后氧和指数低于300 mmHg、术后并发急性肾功能衰竭为婴幼儿CPB手术后发生呼吸功能衰竭的危险因素。结论临床上可根据CPB时间、术中是否二次CPB支持、术后氧和指数、术后是否并发急性肾功能衰竭预测术后呼吸功能衰竭,亦可预先采取措施预防,以减少呼吸功能衰竭的发生。

Analysis of the Risk Factors for Postoperative Respiratory Failure in Infants undergoing Cardiopulmonary Bypass

OBJECTIVE To analyze the risk factors associated with postoperative respiratory failure （PRF） in infants undergoing cardiopulmonary bypass （CPB）. METHODS Between January 2004 and October 2008, 512 patients undergoing CPB were reviewed retrospectively according to the presence or absence of PRF. Multiple perioperative factors were evaluated by univariate and multivariate logistic regression analysis. PRF was defined as mechanical ventilation lasting for more than 48 hours after operation or reintubation at 6 h after extubation for mechanical ventilation. RESULTS 50 patients（9.8% ） developed PRF. Univariate risk factors included cyanotic congenital heart disease（ P 〈 0.01 ）, severe pulmonary hypertension （P 〈0.01）,NYHA functional class Ⅲ or Ⅳ（ P 〈0.01）, plasma albumin（ P =0.01）, CPB time（ P 〈0.01 ） ,aortic cross - clamping time（ P 〈0.01 ） ,secondary CPB support （P 〈0.01 ） ,low ratio of arterial oxygen tension to inspired oxygen fraction （ PaO/FiO2 ） （ P 〈 0.01 ） , duration of mechanical ventilation （ P 〈 0.01 ） , and acute renal failure（ARF） （ P 〈0.01 ） after CPB. Multivariate logistic regression analysis identified that CPB time 〉 150 min, secondary CPB support, PaO/FiO2 〈300 mmHg, and ARF were risk factors. CONCLUSION These results suggest that the patients with risk factors described above need more careful peri and post operative surveillance and management.