婴幼儿先天性心脏病术后机械通气时间延长的影响因素分析

Influencing factors for prolonged mechanical ventilation in infants after cardiac surgery with congenital heart disease

目的 探讨影响婴幼儿先天性心脏病体外循环(CPB)心脏直视手术后机械通气时间延长(PMV)的影响因素。方法 回顾性分析2018年1月—2019年7月在中国科学技术大学附属第一医院需行CPB心脏直视手术的83例先天性心脏病婴幼儿,根据术后机械通气时间分为早期撤机组(<24 h,60例)和晚期撤机组(>24 h,23例),对可能造成PMV的影响因素进行分析比较,包括月龄、体质量、RACHS-1分级、术前是否合并肺炎、左心室射血分数(LVEF)、术前肺动脉压力、术中CPB时间及主动脉阻断(ACC)时间、术中最低酸碱度pH、术后24 h内最高血管活性药物评分(VIS)情况。结果 单因素分析显示:月龄、体质量、术前是否合并肺炎、术前肺动脉压力、术中CPB时间及ACC时间、术后24 h内最高VIS均是婴幼儿先天性心脏病术后PMV的影响因素(均P<0.05)。多因素logistic回归分析显示:术中CPB时间(OR=1.128,95%CI:1.008~1.262,P=0.035)、术后24 h内最高VIS(OR=1.233,95%CI:1.023~1.485,P=0.028)是婴幼儿先天性心脏病术后PMV的独立影响因素。结论 术中CPB时间长、术后24 h内最高VIS高是婴幼儿先天性心脏病术后PMV的主要影响因素。

Objective To investigate the influencing factors of prolonged mechanical ventilation(PMV)in infants with congenital heart disease(CHD)after cardiopulmonary bypass(CPB)open heart surgery.Methods A total of 83 infants with CHD who needed CPB open heart surgery in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to July 2019 were retrospectively analyzed.According to the PMV time,they were divided into early-stage withdrawal group(<24 h,60 cases)and delayed-stage withdrawal group(>24 h,23 cases).The influencing factors of PMV were analyzed and compared,including month age,body weight,RACHS-1 grade,preoperative pneumonia,left ventricular ejection fraction(LVEF),preoperative pulmonary artery pressure,intraoperative CPB time and aortic cross clamp(ACC)time,intraoperative minimum pH,maximum vasoactive-inotropic score(VIS)in the 24 hours after operation.Results There were sixty cases in early-stage withdrawal group and twenty-three cases in delayedstage withdrawal group.Univariate analysis showed that month age,body weight,preoperative pneumonia,preoperative pulmonary artery pressure,CPB time,ACC time,maximum VIS in the first 24 hour after operation were the influencing factors of PMV(P<0.05).Multivariate logistic regression analysis showed that CPB time(OR=1.128,95%CI:1.008-1.262,P=0.035)and maximum VIS in the first 24 hours after operation(0R=1.233,95%CI:1.023-1.485,P=0.028)were the independent influencing factors.Conclusion Long CPB time and high maximum VIS in the first 24 hours after operation are the main influencing factors for PMV of infants with CHD after operation.