胸腔镜心脏手术体外循环后发生低氧血症的危险因素分析:一项单中心回顾性分析

Risk Factors for Hypoxemia during Thoracoscopic Cardiac Surgery after Cardiopulmonary Bypass:A Single-Center Retrospective Analysis

目的探究胸腔镜心脏手术体外循环(cardiopulmonary bypass,CPB)后单肺通气(one-lung ventilation,OLV)期间发生低氧血症的危险因素。方法回顾性分析广东省人民医院2021年6月至2022年6月期间行胸腔镜心脏手术207例患者的临床资料。通过单因素分析和二元Logistic回归分析确定胸腔镜心脏手术CPB后OLV期间发生低氧血症的危险因素。结果胸腔镜心脏手术患者CPB后低氧血症的发生率为29%。单因素分析结果显示两组差异存在统计学意义的指标包括年龄(P=0.020),吸烟史(P<0.001),室间隔厚度(P=0.018),舒芬太尼用量(P=0.017),麻醉时长(P=0.030),超滤量(P=0.023),心肌保护液类型(P=0.035),主动脉阻断时间(P=0.022),CPB时间(P=0.031),手术时长(P=0.036)。二元Logistics回归分析结果示年龄(OR=0.029,P=0.037)、吸烟史(OR=1.638,P<0.001)、室间隔厚度(OR=0.172,P=0.043)是CPB后发生低氧血症的危险因素,而舒芬太尼用量(OR=0.006,P=0.016)是发生低氧血症的保护因素。结论高龄及吸烟史患者行胸腔镜心脏手术时,CPB后OLV期间发生低氧血症风险更大。

Objectives To explore the risk factors for hypoxemia during one-lung ventilation(OLV)after cardiopulmonary bypass(CPB)in thoracoscopic cardiac surgery.Methods Clinical data of patients to propose thoracoscopic cardiac surgery from June 2021 to June 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed.Univariate analysis and binary regression analysis were used to identify the risk factors associated with hypoxemia during OLV after CPB.Results Hypoxemia occurred with the incidence of 29%during OLV after CPB in thoracoscopic cardiac surgery.Univariate analysis results showed that significant differences between the two groups included age(P=0.020),smoking(P<0.001),thicknessofinterventricularseptal(P=0.018),thedoseofsulfentanil(P=0.017),durationofsurgery(P=0.030),ultrafiltration rate(P=0.023),type of myocardial protective fluid(P=0.035),aortic cross clamp duration(P=0.022),the duration of CPB(P=0.031),the duration of surgery(P=0.036).Binary Logistic regression analysis showed that age(OR=0.029,P=0.037),smoking(OR=1.638,P<0.001),interventricular septal thickness(OR=0.172,P=0.043)were risk factors influencing the incidence of hypoxemia,while the dose of sulfentanil was the protect factor of the incidence of hypoxemia after CPB.Conclusions Patients with old age and smoking history have a greater risk of hypoxemia undergoing thoracoscopic cardiac surgery after CPB.