小儿心内直视手术后呼吸机辅助时间延长的危险因素分析

Investigation on risk factors of prolonged mechanical venilation in infants after cardiopulmonary bypass

目的分析小儿心内直视手术后呼吸机辅助时间延长的危险因素。方法将2004年1月~2008年10月间连续512例施行先心病手术患儿,根据术后呼吸机辅助时间是否延长（呼吸机辅助时间延长定义为≥48h）分为两组,组Ⅰ75例,术后呼吸机辅助时间延长;组Ⅱ437例,术后呼吸机辅助时间未延长。先对各变量进行单因素分析,然后将分析有意义的变量纳入Logistic回归进行多因素分析。结果术后呼吸机辅助时间延长75例。单因素分析结果显示：重度肺动脉高压、清蛋白、体外循环时间、主动脉阻断时间、二次体外循环支持、术后氧和指数、引流液总量、术后并发症与术后发生呼吸机辅助时间延长有关。经多因素Logistic回归分析显示：体外循环时间超过150m in,二次体外循环支持,术后氧和指数〈300mmHg,引流液总量超过300m l,术后心、肺、脑、多器官功能衰竭为小儿心内直视手术后呼吸机辅助时间延长的危险因素。结论临床上可根据体外循环时间、术中是否二次体外循环支持、术后氧和指数、引流液总量、术后并发症预测术后呼吸机辅助时间是否延长。对具有上述危险因素的患儿采取更多的防治措施,以减少呼吸机辅助时间延长的发生。

Objective To analyze risk fastors for prolonged mechanical venilation（PMV） after cardiopulmonary bypass（CPB）.Methods Between January 2004 and October 2008,512 patients undergoing open heart surgery were divided into two groups based on if their length of mechanical venilation more than 48 hours（prolonged mechanical venilation was defined as 48 hours or more）.Group I ：75 patients required prolonged mechanical venilation.Group II： 437 patients did not require prolonged mechanical venilation.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Seventy-five patients required prolonged mechanical venilation.Univariate risk factors included severe pulmomary hypertension,plasma albumin〈35g/L,CPB time,aortic cross-clamping time,secondary CPB support,low ratio of arterial oxygen tension to inspired oxygen fraction（PaO2/FiO2）,postoperative drainage,postoperational complication,multivariate logistic regression analysis identified that CPB time〉150min（OR 4.398）,secondary CPB support（OR 18.653）,PaO2/FiO2〈300mmHg（OR 4.606）,the volume of postoperative drainage〉300ml（OR 5.666）,MODS（OR 4.872） were risk factors.Conclusion The patients with there risk factors need more preoperative care and postoperative care to avoid prolonged mechanical venilation after CPB.