成人Ebstein畸形患者矫治术后机械通气拔管延迟的危险因素

Risk factors for delayed extubation of mechanical ventilation in adult patients with Ebstein’s anomaly after correction

目的探讨成人Ebstein畸形矫治术后机械通气拔管延迟的危险因素。方法成人Ebstein畸形患者75例,矫治术后均行呼吸机辅助机械通气,其中正常拔管组50例(机械通气时间≤24 h),延迟拔管组25例(机械通气时间>24 h)。比较2组临床资料,多因素logistic回归分析成人Ebstein畸形矫治术后机械通气拔管延迟的危险因素。结果延迟拔管组术前合并心律失常比率(56.00%)、术后白细胞计数[(22.51±7.61)×10^9/L]、术后血肌酐[(120.83±64.61)μmol/L]较正常拔管组[32.00%、(16.42±5.20)×10^9/L、(81.42±18.04)μmol/L]高(P<0.05),术前白蛋白[(43.78±4.72)g/L]、术后血小板计数[(96.16±25.50)×10^9/L]较正常拔管组[(46.75±5.40)g/L、(130.36±34.62)×10^9/L]低(P<0.05),体外循环时间[(158.64±50.04)min]、主动脉阻断时间[(105.68±35.68)min]较正常拔管组[(118.58±33.43)、(88.98±27.62)min]延长(P<0.05),2组年龄、性别比例、体质量指数等比较差异均无统计学意义(P>0.05);多因素logistic回归分析结果显示,术前合并心律失常(OR=8.016, 95%CI:1.353~17.480,P=0.022)、术后白细胞计数≥18.4×10^9/L(OR=5.164, 95%CI:1.325~20.125,P=0.018)、术后血小板计数≤94×10^9/L (OR=4.889, 95%CI:1.046~22.853,P=0.044)、术后血肌酐≥110μmol/L(OR=6.46,95%CI:1.527~27.332,P=0.011)是成人Ebstein畸形患者矫治术后机械通气拔管延迟的危险因素。结论术前合并心律失常、术后炎症感染、术后有出血倾向及术后肾损伤是成人Ebstein畸形矫治术后机械通气拔管延迟的危险因素。

Objective To explore the risk factors for delayed extubation of mechanical ventilation after the correction of adult Ebstein’s anomaly. Methods A total of 75 adult patients undergoing correction of Ebstein’s anomaly received mechanical ventilation after surgery, and were divided into 50 patients receiving mechanical ventilation ≤24 h(normal extubation group) and 25 patients receiving mechanical ventilation >24 h(delayed extubation group). The clinical data were compared between two groups. Multivariate logistic regression models were used to analyze the risk factors for delayed extubation of mechanical ventilation after correction of Ebstein’s anomaly in adults. Results In delayed extubation group, the rate of preoperative arrhythmia(56.00%), postoperative white blood cell count((22.51±7.61)×10~9/L) and postoperative blood creatinine level((120.83±64.61) μmol/L) were significantly higher than those in normal extubation group(32.00%,(16.42±5.20)×10~9/L,(81.42±18.04) μmol/L)(P<0.05), preoperative albumin level((43.78±4.72) g/L) and postoperative platelet count((96.16±25.50)×10~9/L) were significantly lower than those in normal extubation group((46.75±5.40) g/L,(130.36±34.62)×10~9/L)(P<0.05), and the cardiopulmonary bypass time((158.64±50.04) min) and aortic clamping time((105.68±35.68) min) were significantly longer than those in normal extubation group((118.58±33.43),(88.98±27.62) min)(P<0.05). There were no significant differences in age, sex ratio and body mass index between two groups(P>0.05). Multivariate logistic regression analysis showed that preoperative arrhythmia(OR=8.016, 95%CI: 1.353-17.480, P=0.022), postoperative white blood cell count ≥18.4×10~9(OR=5.164, 95%CI: 1.325-20.125, P=0.018), postoperative platelet count ≤94×10~9(OR=4.889, 95%CI: 1.046-22.853, P=0.044) and postoperative creatinine level ≥110 μmol/L(OR=6.460, 95%CI: 1.527-27.332, P=0.011) were the risk factors for delayed extubation of mechanical ventilation after correction of Ebstein’s anomaly in adults. Conclusion Preoperative arrhythmia, postoperative inflammatory infection, postoperative bleeding tendency and postoperative renal injury are the risk factors for delayed extubation of mechanical ventilation after correction of adult Ebstein’s anomaly.