肺动脉血栓内膜剥脱术后ICU时间延长的术前危险因素分析

Preoperative risk factors of ICU prolongation after pulmonary thromboendarterectomy

目的分析肺动脉血栓内膜剥脱术(PTE)后ICU停留时间延长的术前危险因素。方法对阜外医院1997年3月至2016年10月期间147例肺动脉血栓内膜剥脱手术患者进行回顾性分析,单因素及多因素Logistic回归分析影响患者术后ICU停留时间延长的术前危险因素。结果本研究中患者术后ICU停留时间中位数为5 d,将患者分为ICU停留时间≤5 d组及ICU停留时间>5 d组,单因素分析表明,术后ICU停留时间延长与以下因素有关:女性(P=0.022)、术前右心室舒张末期前后径>30 mm(P=0.003)、术前右心导管测量肺动脉收缩压>80 mmHg(P=0.001)、术前右心导管测量肺动脉平均压>40 mmHg(P=0.004)、术前肺血管阻力(PVR)>1000 dyne·s/cm^5(P<0.001)。多因素Logistic回归分析表明,术后ICU停留时间延长与女性(OR=0.36,95%CI:0.15~0.87)、术前右心室舒张末期前后径>30 mm(OR=2.28,95%CI:1.09~4.78)及术前PVR>1000 dyne·s/cm^5(OR=2.62,95%CI:1.19~5.75)有显著相关性。结论性别、术前右心室扩张程度及PVR大小是影响PTE术后ICU停留时间的术前危险因素。

Objective To identify the preoperative risk factors of prolonged ICU stay after pulmonary thromboendarterectomy(PTE). Methods A total of 147 patients underwent PTE during the period from March 1997 to October 2016 was analyzed retrospectively. Univariable and logistic regression analysis were used to identify the preoperative risk factors for postoperative prolongation of ICU stay. Results Prolongation of ICU stay was defined as the duration of ICU stay greater than 5 days. The patients were divided into ICU residence time≤5 d group and ICU residence time>5 d group. Female(P=0.022), preoperative right ventricular end-diastolic diameter(RVEDD) larger than 30 mm(P=0.003), preoperative mean pulmonary artery systolic pressure measured by right heart catheterization(RHC) greater than 80 mmHg(P=0.001), preoperative mean pulmonary artery pressure measured by RHC greater than 40 mmHg(P=0.004), and preoperative pulmonary vascular resistance(PVR) greater than 1000 dyne·s/cm^5(P<0.001) were demonstrated to be associated with prolongation of ICU stay in univariable analysis. Logistic regression analysis suggested female [OR=0.36, 95% confidence interval(CI): 0.15-0.87], RVEDD larger than 30 mm(OR=2.28, 95% CI: 1.09-4.78), and PVR greater than 1000 dyne·s/cm^5(OR=2.62, 95% CI: 1.19-5.75) were independently related to prolongation of ICU stay. Conclusion Gender, preoperative right ventricular dilatation, and preoperative elevated PVR are the risk factors for prolongation of ICU stay after PTE.