心脏瓣膜手术后呼吸衰竭相关危险因素分析

Predictive Risk Factors for Postoperative Respiratory Failure in Patients Undergoing Valvular Surgery

目的探讨影响心脏瓣膜手术后呼吸衰竭发生的相关危险因素。方法回顾性分析2001年1月至2010年11月兰州军区兰州总医院618例心脏瓣膜疾病患者的临床资料,其中男339例,女279例;年龄10～74(44.01±13.95)岁;风湿性心脏病387例,非风湿性心脏病231例;根据术后是否发生呼吸衰竭分为呼吸衰竭组(74例)和非呼吸衰竭组(544例),采用单因素及多因素logistic回归方法分析术后呼吸衰竭发生的危险因素。结果心脏瓣膜术后早期住院死亡率6.1%(38/618),呼吸衰竭发生率12.0%(74/618)。呼吸衰竭组住院死亡率为17.6%(13/74),非呼吸衰竭组住院死亡率4.6%(25/544),两组差异有统计学意义(χ2=18.994,P=0.000)。单因素分析显示,年龄>65岁(P=0.005)、心功能分级(NYHA)Ⅳ级(P=0.014)、射血分数(EF)<50.0%(P=0.003)、体外循环时间>3 h(P=0.001)、主动脉阻断时间>2 h(P=0.008)、复合手术(同期CABG、主动脉根部置换或射频消融迷宫手术P=0.000)、二次手术(P=0.012)、术后并发症(P=0.000)、输血量>2 000 ml(P=0.000)是心脏瓣膜手术后呼吸衰竭发生的潜在危险因素;多因素logistic回归分析结果显示,复合手术(P=0.003)、二次手术(P=0.010)、术后并发症(P=0.000)、输血量>2 000 ml(P=0.012)是心脏瓣膜手术后呼吸衰竭发生的独立预测因素。结论重视心脏瓣膜术后呼吸衰竭发生的危险因素,加强围手术期处理,缩短体外循环时间,减少并发症,以减少呼吸衰竭的发生,降低病死率。

Objective To analyze risk factors associated with postoperative respiratory failure in patients with valvular surgery.Methods Between January 2001 and November 2010,clinical data of 618 patients with 339 males and 279 fameles at age of 10-74（44.01±13.95） years,undergoing valvular operations were investigated retrospectively.We divided the patients into two groups according to the presence（74 patients） or absence（544 patients）of postoperative respiratory failure.Its risk factors were evaluated by univariate and multivariate logistic regression analysis.Results The hospital mortality rate of valvular surgery was 6.1%（38/618）.The morbidity rate of respiratory failure was 12.0%（74/618） with hospital mortality rate at 17.6%（13/74） which was significantly higher than those patients without postoperative respiratory failure at 4.6%（25/544,χ2=18.994,P=0.000）.Univariate analysis showed age65 years（P=0.005）,New York Heart Association（NYHA） classⅣ（P=0.014）,election fraction50.0%（P=0.003）,cardiopulmonary bypass time3 h（P=0.001）,aortic cross clamping time2 h（P=0.008）,concomitant operation（valvular operation with coronary artery bypass grafting,Bentall or radiofrequency ablation maze operation（P=0.000）,reoperation（P=0.012）,postoperative complications（P=0.000）,and blood transfusion2 000 ml（P=0.000） were important risk factors for postoperative respiratory failure.Multivariate logistic regression showed that concomitant operation（P=0.003）,reoperation（P=0.010）,postoperative complications（P=0.000）,and blood transfusion2 000 ml（P=0.012） were significant independent predictive risk factors.Conclusion This study suggest that patients with predictive risk factors of postoperative respiratory failure need more carefully treated.The morbidity of these patients would be reduced through improving perioperative management,shortening cardiopulmonary bypass time and reducing postoperative complications.