心脏二尖瓣、主动脉瓣双瓣置换术患者ICU停留时间延长的危险因素分析

Analysis of Risk Factors for Prolonged Stay in Intensive Care Unit in Patients after Concomitant Mitral Valve Surgery with Aortic Valve Replacement

目的分析心脏瓣膜（主动脉瓣合并二尖瓣）置换手术患者ICU停留时间延长（ICU时间≥3d）的危险因素。方法回顾性收集武汉市亚洲心脏病医院2009年1月～2011年12月间695例施行心脏双瓣膜置换手术患者的临床资料,先对纳入的31个备选的危险因素进行单因素分析,然后将有统计学意义的单因素变量纳入Logistic回归进行多因素分析,筛选出ICU停留时间延长的危险因素。结果术后ICU停留时间延长31例,停留时间延长的发生率为4.46%。单因素分析结果显示：性别、肺动脉压力、体外循环时间、主动脉阻断时间、呼吸机辅助时间、二次手术、合并心律失常、再次气管插管、合并冠心病史、感染性心内膜炎（3个月内）、心脏有赘生物、左房大小、左室舒张期末径、左室收缩期末径和术前使用静脉扩管剂都具有统计学意义（P〈0.05）。Logistic多因素分析结果显示：二次手术、累计呼吸机辅助时间≥48h、术前左房大、合并冠心病史、体外循环时间≥3h、心脏有赘生物形成和左室收缩末径大是心脏瓣膜置换术后患者ICU停留时间延长的独立危险因素。结论重视影响患者ICU停留时间延长的危险因素,针对上述危险因素采取相应的措施,对缩短ICU停留时间有重要的意义。

Objective To analyze the risk factors for prolonged stay in intensive care unit（ICU）after heart valve replacement surgery（aortic valve concomitant with mitral valve）.Methods Clinical data of 695patients who underwent concomitant mitral valve surgery with aortic valve replacement in the Wuhan Asia Heart Hospital between January 2009and December 2011 were retrospectively analyzed.Thirty-one possible risk factors were first examined by using univariate analysis.Univariate variables that showed a statistical significance were then subjected to the multivariate analysis（Logistic regression）to identify the risk factors for prolonged stay in ICU.Results There were 31patients who had prolonged stay in ICU and the incidence was 4.46%.Univariate analysis showed the following variables had significant differences：gender,pulmonary artery systolic pressure,cardiopulmonary bypass time,aortic cross-clamping time,breathing machine auxiliary time,reoperation,concomitant arrhythmia,tracheal intubation for the second time,concomitant coronary artery diseases,infective endocarditis（within 3 months）,heart with vegetations,left atrium,left ventricular end systolic diameter（LVESD）,left ventricular end diastolic diameter（LVEDD）and use of venodilator before operation（P〈0.05）.Logistic multivariate analysis showed that reoperation, breathing machine auxiliary time≥48h,left atrium enlargement,concomitant coronary artery diseases,cardiopulmonary bypass time≥3h,heart with vegetations and LVESD enlargement were the major risk factors for prolonged stay in ICU.ConclusionMore attention should be paid to the risk factors of the prolonged stay in ICU and appropriate measures should be taken to shorten the ICU stay of patients subjected to concomitant mitral valve surgery with aortic valve replacement.