心脏瓣膜置换术后ICU时间延长危险因素分析

Risk factors for prolonged ICU stay after heart valve replacement

目的：分析心脏瓣膜置换术患者ICU时间延长的危险因素.方法：回顾性分析2009-2011年间2232例瓣膜置换术患者的临床资料,分为术后ICU时间延长组（166例,时间延长定义为ICU时间≥3d）和ICU时间未延长组（2066例）.先进行单因素分析,将单因素分析有显著意义的变量纳入Logistic回归进行多因素分析.结果：单因素分析患者55项因素的结果显示,其中23项因素有统计学差异（P＜0.05）.Logistic回归分析显示：外周血管病史,血培养阳性,术前左房直径≥5.0cm、左室舒张末内径≥7.0cm、左室收缩末内径≥5.0cm、最后一次血肌酐≥135μmol/L,二次手术,体外循环时间≥3h,住院期间再次气管插管,累计呼吸机辅助时间≥48h为术后ICU时间延长的主要危险因素[Wald=4.63～133.86,P＜0.05或＜0.01].结论：对于具有上述危险因素的患者采取更多的有针对性防治措施,有助于缩短ICU时间,减少术后并发症和降低死亡率.

Objective： To analyze risk factors for prolonged stay in ICU after heart valve replacement. Methods.. Clinical data of 2232 patients undergoing heart valve replacement between 2009 and 2011 were retrospectively ana- lyzed. They were divided into prolonged ICU stay group （n = 166, prolonged stay in ICU was defined as ICU stay 3d） and no-prolonged ICU stay group （n = 2066）. Univariate analysis was performed at first, then the variables with statistical significance were brought into Logistic regression analysis to perform multivariate analysis. Results： Uni- variate analysis of 55 risk factors showed that 23 factors were statistical significant （P〈0.05）. Logistic regression a- nalysis indicated that history of peripheral vascular disease, positive blood culture, preoperative left atrial diameter 95.0cm, preoperative left ventricular end-diastolic diameter ≥7. 0cm, preoperative left ventricular end-systolic di- ameter ≥5. 0cm, preoperative last blood creatinine ≥135μmol/L, reoperation, eardiopulmonary bypass time ~ 3h, re-endotracheal intubation during hospitalization, total breathing machine auxiliary time 948 h were the major risk factors for postoperative prolonged ICU stay [Wald with above risk factors need more targeted prevention erative complications and mortality rate. 4. 63-133. B6, P〈0.05 or d0.01]. Conclusion： The patients and treatment, which can help to reduce ICU stay and postop-