主动脉弓替换术后重症监护室时间延长的危险因素

Predictors of Prolonged Intensive Care Unit Stay in Patients Undergoing Aortic Arch Replacement

目的研究主动脉弓替换术后重症监护室(ICU)时间延长的危险因素。方法回顾性分析2005年1月～2006年12月行深低温停循环并顺行选择性脑灌注下主动脉弓替换术(除外一期次全或全主动脉弓替换术)的患者173例。ICU时间延长定义为术后ICU时间≥5d。采用单因素比较和多因素Logistic回归分析围手术期变量与术后ICU时间延长的关系。结果患者平均年龄(45.4±10.6)岁,男性患者占76.3%。38例(22.0%)患者术后ICU时间延长。术后脑卒中和急性肾功能衰竭(定义为术后需要透析治疗)的发生率分别为6.4%和4.6%,住院死亡率为2.9%。单因素分析结果显示体重指数、术前血清肌酐水平、急诊手术、是否行同期冠状动脉旁路移植术、体外循环时间、心肌阻断时间、是否发生术后脑卒中和急性肾功能衰竭与ICU时间延长相关。多因素Logistic回归分析结果显示急诊手术、体外循环时间>180min、术后脑卒中和急性肾功能衰竭是ICU时间延长的独立危险因素。结论主动脉弓替换术后ICU时间延长的发生率较高,临床上可根据危险因素预测主动脉弓替换术后ICU时间延长,加强围手术期脑保护和肾功能保护可能有助于缩短术后ICU时间。

Objective To identify the predictors of prolonged intensive care unit （ICU） stay in patients undergoing aortic arch replacement. Methods The clinical data of 173 consecutive patients undergoing aortic arch replacement requiring deep hypothermic circulatory arrest plus antegrade selective cerebral perfusion were reviewed retrospectively. Patients who had undergone one-stage total or subtotal aortic replacement were excluded. Data collected from records were used to identify univariate and multivariate predictors for prolonged ICU stay, which was defined as longer than 5 days in ICU postoperatively. Results Patients aged （45.4 ± 10.6） years and male accounted for 76.3%. The incidence of prolonged ICU stay was 22.0%. The incidences of postoperative stroke and acute renal failure were 6.4% and 4.6% , respectively. The in-hospital mortality rate was 2.9%. Univariate predictors for prolonged ICU stay included body mass index, preoperative serum creatinine level, emergent surgery, coronary artery bypass grafting at the same time, cardiopulmonary bypass time, myocardial ischemic time, and occurrence of postoperative stroke and/or acute renal failure. Multivariable modeling identified that emergent surgery （ odds ratio [ 95% confidence interval ] -3.1 [ 1.3, 7.6 ] ）, cardiopulmonary bypass time longer than 180 min （ 3.3 [ 1.4, 8.1 ] ）, postoperative stroke （6.9 [ 1.1, 43.1 ] ） and acute renal failure （ 14.5 [ 1.3, 161.6] ） were the independent predictors for prolonged ICU stay. Conclusions The incidence of prolonged ICU stay is high after aortic arch replacement. Patients with identified multivariate predictors carry a higher risk of prolonged ICU stay and may benefit from enhanced perioperative protection of brain and kidney.