术中通气模式对体外循环下成人心脏手术后肺部并发症影响的回顾性队列研究

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study

目的评估术中通气模式对体外循环下成人心脏手术患者术后肺部并发症(postoperative pulmonary complications,PPCs)的影响。方法回顾性分析2020年6—12月于四川大学华西医院行择期体外循环下心脏手术604例患者的临床资料,其中男293例、女311例,平均年龄(52.0±13.0)岁。按照通气模式将患者分为3组:压力控制通气-容量保证通气(pressure-controlled ventilation-volume guarantee,PCV-VG)组(201例)、压力控制通气(pressure-controlled ventilation,PCV)组(200例)、容量控制通气(volume-controlled ventilation,VCV)组(203例)。通过改良Poisson回归模型分析术中通气模式与PPCs之间的关系,PPCs包括术后7 d内的肺炎、呼吸衰竭、肺不张、胸腔积液、气胸。结果共246例(40.7%)患者发生了PPCs,其中PCV-VG组86例(42.8%)、PCV组75例(37.5%)、VCV组85例(41.9%)。改良Poisson回归分析显示,以VCV组作为对照,PCV-VG组和PCV组患者术后7 d内PPCs发生率差异无统计学意义[a RR=0.951,95%CI(0.749,1.209),P=0.683;a RR=0.827,95%CI(0.645,1.060),P=0.133]。结论对于体外循环下成人心脏手术患者,术中通气模式与术后7 d内PPCs无相关性。

Objective To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications(PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass(CPB). Methods The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee(PCV-VG) group(n=201), a pressure-controlled ventilation(PCV) group(n=200) and a volume-controlled ventilation(VCV) group(n=203). The association between intraoperative ventilation modes and PPCs(defined as composite of pneumonia, respiratory failure, atelectasis,pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results The PPCs were found in a total of 246(40.7%) patients, including 86(42.8%) in the PCV-VG group, 75(37.5%) in the PCV group and 85(41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode(a RR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode(a RR=0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.