ICU术后机械通气时间影响因素的临床分析

Clinical analysis of factors related to the length of postoperative mechanical ventilation in ICU

目的 分析术后患者机械通气时间的影响因素。方法对近半年来114例外科手术后转入麻醉科ICU监护治疗患者的机械通气时间、ASA分级、APACHⅡ、手术部位、手术时间、术中芬太尼用量、白蛋白水平、红细胞压积、入ICU时氧合指数等指标进行多元线性回归分析。结果 决定外科手术术后患者机械通气时间的主要影响因素按顺序依次为复杂心脏手术、手术时间、简单心脏手术、白蛋白水平、氧合指数。结论可以根据患者手术部位、手术时间和心肺功能大致决定需要机械通气的时间,在围术期应积极纠正患者的低蛋白血症,改善氧合状态,以尽量缩短机械通气时间,减少患者在ICU滞留时间以及降低医疗费用。

Objective To analyze the factors related to postoperative mechnical ventilation time in ICU. Methods The 114 patients cared in ICU after surgery during October 2003 to February 2004 were retrospectively studied. Multivariate linear regression was employed to analyse the relevant factors, including ASA, APACHII, operation region, operation time, dose of fentanyl, serum albumin and oxygenation index. Results Regression analysis revealed the major factors correlated with ventilation time included complicated heart surgery, operation time, simple heart surgery, albumin and oxygenation index ( P < 0.001). Operation time was positively correlated with ventilation time ( P < 0.001), whereas albumin ( P < 0.001) and oxygenate index ( P < 0. 05) were negatively correlated with ventilation time. The ventilation after complicated heart surgery (19.45 h) was longer than that after the operation over other regions ( P < 0.001 in all); ventilation after simple heart surgery was longer than after thoracic surgery (8 .49 h vs 5 .87 h, P < 0.05). Conclusion The length of ventilation required may roughly be judged according to operation region, operation time and cardiopulmonary functions. Active perioperative treatments to correct hypoproteinemia and improve oxygenation are emphasized to shorten the postoperative ventilation time and stay in ICU, and reduce the medical expenses rationally.