冠状动脉旁路移植术后延迟拔管病例对照研究

Case control study of prolonged mechanical ventilation following coronary artery bypass grafting

目的 探讨冠状动脉旁路移植术（CABG）后延迟拔管的危险因素。方法回顾性纳入2008年1月至2013年1月宜昌市第一人民医院重症医学科CABG术后全部患者，以延迟拔管术后机械通气（〉48h）者作为观察组，以术后无延迟拔管的患者作为对照。对潜在危险因素进行对比分析，并采用非条件logistic多元回归分析。结果共收治CABG术后患者92例，其中延迟拔管患者24例，发生率为35．29％。单因素分析结果显示，低心排、近期心梗、IABP、急诊手术、再次手术、CRRT、术后住ICU时间延长是CABG术后延迟拔管的高危因素。Logistic多因素回归分析显示，术后低心排[优势比（OR）=11．809，95％可信区间（95％CI）为（2．61353．364）]是CABG术后延迟拔管的独立危险因素（P〈0．05）。结论低心排是CABG术后延迟拔管的独立危险I天l素．

Objective To find out the risk factors of prolonged mechanical ventilation following coronary artery bypass grafting （CABG）in ICU to provide reference for effective control measure. Methods The method of retrospective case-control study and multivariable logistic regression analysis were adopted. All the patients （frome January 2008 to January 2013） who had stay in ICU following CABG were investigated. 24 ones as cases group who had prolonged mechanical ventilation following CABG （mechanical ventilation time〉48 h）, the others were control. Results All the patients（92 ones） undergoing CABG were analyzed retrospectively. Among in them, 24 cases had prolonged mechanical ventilation following CABG, the morbidity rate was 35.29%. Univariate analysis of risk factors for prolonged mechanical ventilation following CABG were postoperative low cardiac output syndrome, myocardial infarction, IABP, emergent operation, reoperation, CRRT, postoperative prolonged stay in ICU. Compare with the control patients, the independent risk factors of prolonged mechanical ventilation following CABG were postoperative low cardiac output syndrome OR 11.809,95.0%CI [2.613 53.364]. Conclusion The independent risk factors of prolonged mechanical ventilatlon following CABG are postoperative low cardiac output syndrome.