老年心脏外科术后呼吸系统急危重症危险因素分析

Analysis of risk factors of respiratory critical illness after cardiac surgery in the elderly

目的分析老年心脏外科术后呼吸系统急危重症的危险因素。方法回顾性选取2022年5月至11月于阜外华中心血管病医院就诊并接受心脏外科手术的住院患者686例为研究对象。依据是否发生术后肺部并发症(postoperative pulmonary complications,PPCs)分为PPCs组(122例)和对照组(564例)。收集患者基线信息后,对各项指标进行单因素分析,获取P<0.05的指标纳入多因素logistic回归分析,以是否发生PPCs为因变量,以基线指标为自变量,确定PPCs的独立危险因素。采用χ^(2)检验。结果PPCs组男65例,女57例,年龄≥70岁86例(70.49%),病程>3年82例(67.21%)。对照组男293例,女271例,年龄≥70岁304例(53.90%),病程>3年242例(42.91%)。由logistic回归分析可知,年龄≥70岁(OR=4.855,95%CI:1.981~7.728)、病程>3年(OR=4.678,95%CI:1.908~7.447)、吸烟史>3年(OR=23.248,95%CI:9.843~36.653)、术前纽约心脏病学会(NYHA)分级Ⅲ~Ⅳ级(OR=4.567,95%CI:1.984~7.150),高血压(OR=29.871,95%CI:11.390~48.352)、糖尿病(OR=4.343,95%CI:1.875~6.812)、哮喘(OR=31.134,95%CI:13.612~48.655)、呼吸暂停综合征(OR=3.282,95%CI:1.317~5.247),手术时长>45 min(OR=18.722,95%CI:6.781~30.663)、手术体位仰卧位(OR=4.299,95%CI:1.598~7.000)、肺顺应性T值<70%正常值(OR=6.826,95%CI:2.627~11.025)、贫血(OR=4.150,95%CI:1.696~6.603)、急诊手术(OR=23.495,95%CI:8.998~37.991)、慢性阻塞性肺疾病(COPD)(OR=5.663,95%CI:2.004~9.322)是老年心脏外科术后呼吸系统急危重症的危险因素(均P<0.05)。结论老年心脏外科术后呼吸系统急危重症logistic风险预测因子指标明确,可有效预测并发症发生,期待大样本、前瞻性循证临床试验开展以完善该预测方程。

Objective To analyze the risk factors of respiratory critical illness after cardiac surgery in the elderly.Methods A total of 686 inpatients who underwent cardiac surgery in Fuwai Central China Cardiovascular Hospital from May to November 2022 were retrospectively selected as the study objects,and they were divided into a PPCs group(122 cases)and a control group(564 cases)according to whether the postoperative pulmonary complications(PPCs)occurred.After collecting the patients'baseline information,univariate analysis was performed for each index,and the indexes with P<0.05 were included in the multivariate logistic regression analysis.With the occurrence of PPCs as the dependent variable and baseline characteristics as the independent variables,multivariate logistic regression analysis was used to determine the independent risk factors for PPCs.χ^(2) test was used.Results There were 65 males and 57 females in the PPCs group,86 cases(70.49%)aged≥70 years,and 82 cases(67.21%)with course of disease>3 years.There were 293 males and 271 females in the control group,304 cases(53.90%)aged≥70 years,and 242 cases(42.91%)with course of disease>3 years.Logistic regression analysis showed that age≥70 years old(OR=4.855,95%CI:1.981-7.728),course of disease>3 years(OR=4.678,95%CI:1.908-7.447),smoking history>3 years(OR=23.248,95%CI:9.843-36.653),initial New York Heart Association(NYHA)grade III-IV(OR=4.567,95%CI:1.984-7.150),hypertension(OR=29.871,95%CI:11.390-48.352),diabetes(OR=4.343,95%CI:1.875-6.812),asthma(OR=31.134,95%CI:13.612-48.655),apnea syndrome(OR=3.282,95%CI:1.317-5.247),operation time>45 min(OR=18.722,95%CI:6.781-30.663),operation in supine position(OR=4.299,95%CI:1.598-7.000),lung compliance T value<70%of normal value(OR=6.826,95%CI:2.627-11.025),anemia(OR=4.150,95%CI:1.696-6.603),emergency surgery(OR=23.495,95%CI:8.998-37.991),and chronic obstructive pulmonary disease(COPD)(OR=5.663,95%CI:2.004-9.322)were the risk factors of respiratory critical illness after cardiac surgery in the elderly(all P<0.05).Conclusions The logistic risk predictors of respiratory critical illness after cardiac surgery in the elderly are clear,which can effectively predict the occurrence of complications.We look forward to conducting large-sample,prospective evidence-based clinical trials to improve the prediction equation.