主动脉夹层术后机械通气延长的非氧合相关因素分析

Non-oxygenation factors relate with postoperative prolonged mechanical ventilation in aortic dissection patients

目的分析主动脉夹层术后机械通气时间延长的非氧合相关危险因素。方法选择2010至2015年主动脉夹层术后患者，按照是否机械通气时间〉48h分为机械通气延长组和非延长组。记录患者人口学、超声心动数据、生化、凝血、炎症等指标，分析机械通气延长氧合因素以外的相关危险因素。结果患者240例，平均年龄（50±12）岁。术后机械通气延长者占35％，相关分析显示：术前白细胞计数（r=0．241，P=0．003）、急诊手术（r=0．263，P=0．004）、Debakey分型（r=-0．379，P=0．000）、手术时间（r=0．329。P=0．ooo）、入室舒张压（r=-0．205，P=0．007）、入室心率（r=0．246．P=0．001）、人室血红蛋白（r=-0．213，P：0．005）、术后血钙（r=-0．262，P=0．001）、术后血糖（r=0．274，P=0．000）、术后乳酸（r=0．272，P=0．000）、心包积液（r=0．239，P=0．032）与主动脉夹层术后与机械通气时间延长相关；Logistic回归显示危险因素为：手术时间，术前白细胞计数及人室血钙，OR值分别为：2．063、1．285、0．016（均P〈0．05）。结论术前白细胞、急诊手术、Debakev分型、手术时间、入室舒张压、心率、术后血钙、血糖、乳酸、心包积液与主动脉夹层术后机械通气时间延长相关。手术时间，术前白细胞计数增高及入室血钙降低为危险因素。

Objective To identify the correlative and risk factors of non-oxygenation factors associated with postoperative prolonged mechanical ventilation （PMV） of aortic dissection（AD）. Methods AD patients undergoing surgery during January 2010 and January 2015 were enrolled. Prolonged mechanical ventilation was defined that duration of ventilation more than 48 h. Results There were 240 patients, average age was （50 ± 12）years. The correlative factors with postoperative PMV were： pre-opervative white blood cell （WBC） （ r = 0. 241, P = 0. 003 ） , emergency operation （ r = 0. 263, P = 0. 004 ） , Debakey type （ r = - 0. 379, P = 0. 000） , duration of operation （ r = 0. 329, P = 0. 000 ） , postoperative diastolic pressure （ r = - 0. 205, P = 0. 007 ） , heart rate （ r = 0. 246, P = 0. 001 ）, postoperative hemoglobin （ r = - 0. 213, P = 0. 005 ） , calcium （ r = - 0. 262, P = 0. 001 ） , glucose （ r = 0. 274, P = 0. 000） , lactate （ r = 0. 272, P = 0. 000） and pericardial effusion （ r = 0. 239, P = 0. 032 ）. Logistic analysis indicated that ： the duration of operation, WBC and postoperative blood calcium were： 2. 063, 1. 285, 0. 016, respectivly（ all P 〈 0.05 ）. Conclusions The correlative factors were： preoperative WBC, emergency operation, Debakey Type, duration of operation, heart rate, postoperative diastolic pressure, hemoglobin, calcium, glucose, lactate, and pericardia] effusion. Duration of operation, WBC and postoperative blood calcium were risk factors predicting PMV.