心脏瓣膜置换术后肺部并发症的多因素分析

Analysis of related factors of pulmonary complications after heart valve replacement

目的分析心脏瓣膜置换术后肺部并发症的相关因素,探讨肺部并发症发生的影响因子及高危因素。方法回顾性分析2009年6月至2014年6月遵义医学院附属医院胸心外科490例心脏瓣膜置换患者的临床资料,把性别、年龄、肥胖、抽烟、糖尿病(DM)、上呼吸道感染(URTI)、慢性阻塞性肺疾病(COPD)、脑血管病变、肺动脉高压(PAH)、体外循环转流时间(CPBT)、主动脉阻断时间(ACCT)、手术时间(OT)、术后呼吸机辅助通气时间、单双瓣膜置换及术后2 h氧和指数(OI)等作为肺部并发症的相关因子,对入选病例进行单因素分析及多因素Logistic分析发生肺部并发症的独立危险因素。结果 490例心脏瓣膜置换患者,术后发生肺部并发症124人,总发生率为25.3%。其中肺部感染42例(8.6%),肺不张23例(4.69%);肺间质水肿(或侵润)21例(4.28%);呼吸衰竭17例(3.47%);气胸6例(1.22%);术后死亡共18例,总死亡率3.67%。结论单因素分析提示心脏瓣膜置换术后肺部并发症与男性、老年、糖尿病、总手术时间、体外循环时间、主动脉阻断时间相关。多因素Logistic分析提示老年患者、糖尿病与总手术时间是肺部并发症的独立危险因素。

Objective To analysis of related factors of pulmonary complications after heart valve replacement,discussing the influence factors of pulmonary complications and risk factors.Methods A retrospective analysis from June2009-June2014,according to the cardiac surgery clinical data of490patients with heart valve replacement of the department of Thoracic and Cardiovascular Surgery of the Affilicated Hospital of Zunyi Medical University.The sex,age,obesity,smoking,diabetes mellitus(DM),upper respiratory tract infection(URTI),chronic obstructive pulmonary disease(COPD),cerebrovascular disease,pulmonary hypertension(PAH),extracorporeal circulation flow time(CPBT),aortic block(ACCT),operation time(OT),postoperative respirator assisted ventilation time,single and double valve replacement and postoperative2hours and oxygen index(OI)were analyzed as pulmonary complication related factors.Single factor analysis of selected cases and Logistic analysis retrospectively on independent risk factors for pulmonary complications were performed.Results490patients with cardiac valve replacement were diagnosed with pulmonary complications,with a total incidence of25.3%.The lung infection was42(8.6%)and atectasis23(4.69%).21cases(4.28percent)of interstitial edema(or infiltration)of the lung.Respiratory failure17(3.47%);Pneumothorax6(1.22%);The total mortality rate was3.67percent.Conclusion Single factor analysis suggests pulmonary complications after heart valve replacement are related to male,old age,diabetes,total operation time,extracorporeal circulation time,and aorta blocking time correlation.Retrospective Logistic analysis suggests that elderly patients,diabetes and total surgical time are independent risk factors for pulmonary complications.