开胸心脏术后机械通气时间延长影响因素分析

目的探讨开胸心脏术后机械通气时间延长的围术期影响因素,为临床护理工作提供参考。方法使用自行设计的资料收集表,收集2014年10月至2016年6月222例入住心脏外科的开胸心脏手术患者的社会人口学资料,开胸手术前后心、肺及肾功能指标,手术基本资料和术后机械通气时间,筛选机械通气时间延长的影响因素。结果成人心脏手术后机械通气时间延长(>24h)发生率25.2%。Logistic回归分析显示,机械通气时间延长的影响因素包括NYHA分级Ⅳ级(OR=37.266,P=0.002)、既往有心脏手术史(OR=4.755,P=0.020)、术中红细胞输注量(OR=1.192,P=0.010)、术后发生室性心律失常(OR=12.068,P=0.000)、应用1种血管活性药物(OR=5.139,P=0.000)、应用3种或以上血管活性药物(OR=8.677,P=0.002)。结论成人心脏手术后机械通气时间延长的发生率高,其围术期影响因素较多,需加强危险因素评估,加强针对性护理,以缩短机械通气时间,减少术后并发症。

Preoperative risk factors of prolonged mechanical ventilation in adult patients after cardiac surgery: a retrospective study

Objective To explore the risk factors of prolonged mechanical ventilation in adult patients after cardiac surgery. Methods The retrospective study enrolled 222 consecutive adult patients undergoing cardiac surgery from Oct 2014 to Jun 2016.Demogra- phic data, perioperative clinical data of heart, lung and kidney function, operation data and postoperative mechanical ventilation time were collected from each patient using a self-designed questionnaire. Results The incidence rate of prolonged mechanical ventilation (>24 h) was 25.2%.Logistic regression indicated that, NYHA class IV ( OR =37.266, P =0.002), previous cardiac surgery ( OR =4.755, P =0.020), red blood cell transfusion volume during the surgery ( OR =1.192, P =0.010), postoperative ventricular arrhythmia ( OR =12.068, P =0.000), postoperative usage of 1 kind of vasoactive agents ( OR =5.139, P =0.000), postoperative usage of 3 kinds of or more vasoactive agents ( OR =8.677, P =0.002), were risk factors of prolonged mechanical ventilation in adult patients after cardiac surgery. Conclusion The incidence of prolonged mechanical ventilation in adult patients undergoing cardiac surgery is high. Many factors contributed to cause prolonged mechanical ventilation. Measures should be taken to target the risk factors, and nursing care plan should be tailored to the risk factors, so as to shorten the length of mechanical ventilation, and reduce incidence of postoperative complications.