不停跳冠状动脉搭桥术后二次气管插管的临床分析

The clinical analysis of reintubation after off-pump coronary artery bypass grafting

目的 探讨不停跳冠状动脉搭桥（OPCAB）术后二次气管插管的原因及预后.方法 回顾性分析我院2000年7月至2014年7月间共2535例OPCAB患者,比较术后二次气管插管组（R组）和无再次气管插管组（N组）病例资料和围手术期临床因素,包括术后并发症和住院死亡率.术后R组57例,男性39例,女性18例,年龄42～78岁（平均67.4岁）.结果 二次插管发生率2.25％（57/2535）.49例患者痊愈,8例患者死亡,死亡率14.04％.二次插管多发生在术后的24～48 h,占总数的66.67％（38/57）.二次插管原因为心功能不全,肺部感染、水肿,肾功能衰竭,长期吸烟史.高龄与心功能不全是二次气管插管的单因素变量.多因素回归分析发现独立危险因素是：术前低射血分数（P=0.011,OR =2.91,95％CI 1.12～6.78）、术后低射血分数（P=0.005,OR=10.12,95％CI3.25～27.21）,合并慢性肺疾病（P=0.042,OR=1.79,95％CI 1.08～2.79）、肾功能不全（P=0.016,OR =2.84,95％CI 2.47～7.03）,吸烟指数＞400（P=0.001,OR =4.20,95％CI 1.26～14.03）.结论 OPCAB术后二次气管插管的主要原因是心功能不全、呼吸功能不全及肾功能衰竭.二次插管增加患者死亡率及术后并发症.

Objective To investigate the causes of reintubation after off-pump coronary artery bypass grafting （OPCAB）. Methods The clinical data were retrospectively studied in 57 cases with reintubation after 2535 OPCAB from July 2000 to July 2014. The patients who required reintubation after OPCAB were compared with patients not requiring reintubation regarding preoperative clinical variables. Results 2.25% of the 2535 patients required reintubation due to cardiac, respiratory dysfunction, renal insufficiency, 8 patients were dead. The most reintubation were performed in the 24-48 hours after OPCAB 66.67%（38/57）. Advanced age and beart dysfunction were determined as univariate predictors of reintubation. Multiple logistic regression analysis revealed lower preoperative EF（P=O.011, OR =2.91,95% CI 1.12-6.78 ）, lower postoperative EF （P=0.005, OR = 10.12,95% CI 3.25-27.21 ）, combined with COPD （P=0.042, OR = 1.79,95% CI 1.08-2.79 ）, insufficiency （P=0.016, OR = 2.84,95%CI 2.47-7.03）, smoking index〉400 （P=0.001,OR=4.20,95%CI 1.26-14.03）. Conclusion In our study, the most causes of reintubation were cardiac, respiratory dysfunction and renal failure. Mortality and postoperative complications of patients were increased after reintubation.