心脏瓣膜病换瓣术后延迟拔管危险因素分析

Risk factors of delayed extubation after cardiac valvular replacement surgery

目的探讨心脏瓣膜病换瓣术后延迟拔管的危险因素，为制定延迟拔管的防治措施提供依据。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9月心脏瓣膜病换瓣术后的77例患者的临床资料，采用回顾性病例对照研究，以延迟拔管（机械通气时间〉48h或拔管后再插管）19例作为观察组，无延迟拔管58例作为对照组。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换瓣术后患者77例，其中心脏瓣膜病换瓣术后延迟拔管患者19例，发生率为24．67％（19／77）。单因素分析结果显示：术前。肾功能损害（x2=12．396，P=0．000）、术后肾功能损害（x2=4．398，P=0．036）、年龄I〉50岁（x2=12．788，P=0．036）、性别（x2=5．416，P=0．020）、血液净化（x2=15．374，P=0．000）为心脏瓣膜病换瓣术延迟拔管的危险因素。Logistic多因素回归分析显示，心脏瓣膜病换瓣延迟拔管的独立的危险因素是：血液净化（OR15．890，95．0％CI1．432～176．295）、术前肾功能损害（OR8．536，95．O％CI1．059—68．786）（P均〈0．05）。结论术前肾功能损害是心脏瓣膜病换瓣术后延迟拔管的独立危险因素。

Objective To investigate the risk factors of delayed extubation undergoing cardiac valvular surgery in ICU and to provide base for effective control measure. Methods Case-control study was performed on 77 patients who undergone cadiac vavular surgery from January 2008 to September 2012 in the People＇s Hospital of Three Gorge University. Among the patients, 19 cases with mechanical ventilation time 〉 48 h or repeat endotracheal intubation were selected as case group and the other 58 patients were as our control group. Muhivariable logistic regression analysis was adopted to analyze the potential risk factors. Results Of all patients, 19 patients were with prolonged mechanical ventilation, and the rate of delayed extubation was 24. 67% （19/77）. Univariate analysis of risk factors showed that preoperative renal damage（ x2 = 12. 396, P = 0. 000）, postoperative renal damage （ X2 = 4. 398, P = O. 036 ）, age 〉I 50 year（ x2 = 12. 788, P = O. 000 ）, gender （ female ） （ X2 = 5.416, P = O. 020 ） and blood purification （ X2 = 15. 374, P = O. 000 ） were the risk factors of delayed extubation undergoing cardiac valvular surgery. Multivariable logistic regression analysis indicated that blood purification （ OR = 15. 890,95% C1 = 1. 432 - 176. 295 ,P 〈0. 05） and preoperative renal failure （ OR = 8. 536, 95% CI = 1. 059 - 68. 786, P 〈 O. 05 ） were the independent risk factors. Conclusion Preoperative renal dysfunction is the independent risk factors of delayed extubation undergoing cardiac valvular surgery.