心脏瓣膜病瓣膜置换术后住重症监护病房时间延迟的危险因素分析

Analysis of risk factors for prolonged stay in intensive care unit after cardiac valve replacement

目的 探讨某地区心脏瓣膜病瓣膜置换术后住重症监护病房（intensive care unit,ICU）延迟的危险因素,为制定心脏瓣膜病瓣膜置换术后住ICU延迟的防治措施提供依据.方法 采用回顾性病例对照研究和非条件Logistic多元回归分析方法,选择宜昌市第一人民医院重症医学科2008年1月至2012年1月心脏瓣膜病瓣膜置换术后的77例患者研究,住ICU时间延迟（术后ICU时间＞5 d）患者作为住ICU延迟组,以住ICU时间无延迟患者作为对照组.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 共收治心脏瓣膜病瓣膜置换术后患者77例,其中心脏瓣膜病瓣膜置换术后住ICU延迟患者1 1例,心脏瓣膜病瓣膜置换术后住ICU延迟发生率为14.28％.单因素分析结果显示：血液透析、术前肾功能损害、术后呼吸衰竭为心脏瓣膜病瓣膜置换术后住ICU时间延迟的危险因素.Logistic多因素回归分析显示,心脏瓣膜病瓣膜置换术后住ICU延迟的独立的危险因素是术后呼吸衰竭（OR =27.481,95％ CI：2.477～304.89）；血液透析（OR =8.438,95％ CI：1.020～69.816）.结论 术后呼吸衰竭、血液透析是心脏瓣膜病瓣膜置换术后住ICU时间延迟的独立的危险因素.

Objectives To explore the risk factors of staying in intensive care unit （ICU） after cardiac valve replacement as to provide reference for effective control measures.Methods The method of retrospective case-control study and multivariable logistic regression analysis were adopted.We investigated the clinical data of 77 patients in ICU after cardiac valve replacement （from January 2008 to January 2012 in The First People＇s Hospital of Yichang）.Patients with a prolonged ICU stay （〉5 d） after cardiac valve replacement were investigated as case group,and others without prolonged ICU stay were as control group.The potential risk factors between the two groups were compared.Multivariable non-conditional logistic regressions analysis was adopted to determine the independent risk factors affected prolonged stay in ICU after cardiac valve replacement.Results Totally 77 patients after cardiac valve replacement were analyzed retrospectively.Among them,11 cases had a prolonged stay in ICU,thus the occurance rate was 14.28%.Univariate analysis showed risk factors for prolonged ICU stay were postoperative respiratory failure,preoperative renal damage,continuous renal replacement therapy （CRRT）.The independent risk factors of prolonged ICU stay after cardiac valve replacement were postoperative respiratory failure （OR =27.481,95% CI：2.477-304.89） ; CRRT （OR =8.438,95% CI：1.020-69.816）.Conclusions The independent risk factors of prolonged stay in ICU after cardiac valve replacement are postoperative respiratory failure and CRRT.