快通道麻醉心肺转流下冠状动脉旁路移植术后早期低氧血症的危险因素分析

Risk factors of early hypoxemia after coronary artery bypass grafting under fast track anesthesia

目的分析行快通道麻醉体外循环冠状动脉旁路移植术(CCABG)后转入ICU患者出现低氧血症的危险因素。方法回顾性分析2021年11月至2022年2月泰达国际心血管病医院ICU接收的286例CCABG患者的临床资料。根据患者入ICU 30 min的氧合指数(PaO2/FiO2)进行分组。PaO2/FiO2>300 mmHg为非低氧血症组,≤300 mmHg为低氧血症组。其中非低氧血症组134例,低氧血症组152例,对两组患者的临床资料进行单因素和多因素Logistic回归分析。结果286例患者发生低氧血症的发生率为53.1%(152/286)。单因素分析结果显示,与非低氧血症患者比较,体重指数(BMI)、术前PaO2/FiO2,术后血糖、肺不张、心包积气、胸腔积液在两组之间差异具有统计学意义(均P<0.05)。多因素Logistic回归分析显示,术后出现低氧血症的危险因素为BMI(OR=1.275,95%CI:1.154~1.408,P<0.001)和术后肺不张(OR=2.710,95%CI:1.521~4.828,P<0.001)。结论CCABG术后早期低氧血症在临床常见,BMI和术后肺不张为低氧血症的相关独立危险因素。

Objective To analyze the risk factors of hypoxemia in patients transferred to intensive care unit(ICU)after coro⁃nary artery bypass grafting(CABG)under fast track anesthesia.Methods The clinical data of 286 CABG patients received in ICU of Tedda International Cardiovascular Hospital from November 2021 to February 2022 were retrospectively analyzed.The patients were di⁃vided into non-hypoxemia group(P/F>300 mmHg,n=134)and hypoxemia group(P/F≤300 mmHg,n=152)according to the oxy⁃genation index(PaO2/FiO2,P/F)of 30 min after ICU admission.The clinical data of the two groups were analyzed by univariate and multivariate logistic regression analysis.Results The incidence of hypoxemia in 286 patients was 53.1%(152/286).Univariate anal⁃ysis showed that compared with non-hypoxemia patients,there were statistically significant differences in body mass index(BMI),preoperative P/F,postoperative blood glucose,atelectasis,pericardial gas and pleural effusion between the two groups(all P<0.05).Multivariate logistic regression analysis showed that the risk factors for postoperative hypoxemia were BMI(OR=1.275,95%CI 1.154-1.408,P<0.001)and atelectasis(OR=2.710,95%CI 1.521-4.828,P<0.001).Conclusion Early hypoxemia after CABG sur⁃gery is common in clinical practice,and BMI and postoperative atelectasis are independent risk factors associated with hypoxemia.