心脏及大血管外科术后并发急性肺损伤的多因素分析

Multivariate analysis of acute lung injury after cardiac and macrovascular surgery

目的探讨心脏及大血管手术后急性肺损伤(ALI)的发生及其相关危险因素。方法回顾性分析2017年1月至2020年12月我院心胸外科行心脏或大血管手术的患者,整理其临床资料,统计ALI的发病及其相关高危因素。结果1440例心脏及大血管手术患者,心脏外科手术1239例,大血管手术201例,并发ALI175例(12.15%)。急诊手术、高风险手术、心功能差、高龄、术前合并肺部基础疾病、手术或体外循环时间长是发生ALI的最常见危险因素;其次是吸烟史、并发其他肺部损伤(气胸、胸腔积液、膈神经损伤、气道损伤、肺静脉狭窄等)、谵妄、营养差以及肾功能不全。结论心脏及大血管手术患者,病情急缓、手术创伤大小、心功能、手术或体外循环时间、年龄以及是否合并肺部基础疾病是引起术后ALI的最主要原因,需做好充分的术前准备,并随时警惕发生ALI的可能。

Objective To investigate the incidence and risk factors of acute lung injury(ALI)after cardiac and macrovascular surgery.Methods From January 2017 to December 2020,the clinical data of patients who underwent cardiac or macrovascular surgery in our hospital were reviewed and the incidence of ALI and its related risk factors were analyzed.Results Among the 1440 patients undergoing cardiac and macrovascular surgeries,1239 patients underwent cardiac surgery and 201 underwent aortic or macrovascular surgery.Among them,there were 175(12.15%)developing ALI.The most common risk factors for ALI were emergency operation,high-risk operation,poor cardiac function,old age,preoperative pulmonary diseases,long operation and cardiopulmonary bypass time.And then they were followed by smoking history,complicated with other lung injuries(pneumothorax,pleural effusion,phrenic nerve injury,airway injury,pulmonary vein stenosis,etc.),delirium,poor nutrition and renal insufficiency.Conclusion The most important causes of postoperative ALI in patients undergoing cardiac or macrovascular surgery are the critical condition,surgical risk classification,cardiac function,operation and cardiopulmonary bypass time,age,complications of other lung diseases.It is necessary to make full preoperative preparation for these patients and be alert for the possibility of ALI at any time.