术后呼吸道管理对行心脏瓣膜置换术的慢性阻塞性肺疾病患者的影响及预后

Effect and prognosis of postoperative respiratory tract management on patients with chronic obstructive pulmonary disease undergoing cardiac valve replacement

目的 :探究行心脏瓣膜置换术的慢性阻塞性疾病患者术后进行呼吸道管理的临床意义。方法 :将2009年3月~2014年4月期间在我院接受治疗的43例行心脏瓣膜置换术的COPD患者随机分为观察组和对照组,其中对照组21例患者术后给予常规药物治疗,观察组22例患者术后在常规药物治疗的基础上增加呼吸道管理。比较两组患者术后治疗后的心肺功能指标的差异,分析两组患者术后住院时间、呼吸机使用时间及出院后3~12月内再入院数的差异性,分析两组患者术后2年累积生存率及出院后发生死亡的相关危险因素。结果 :术后治疗后观察组与对照组的患者心肺功能指标数值差异均具有统计学意义;观察组患者术后在住院时间、呼吸机使用时间及出院后3~12月内再入院数与对照组有显著差异;运用Logistic多因素逐步回归分析方法分析两组患者术后两年死亡病例相关危险因素,经分析发现年龄≥60岁、心功能IV级及并发症是两组患者出院后发生死亡的相关危险因素。结论 :慢性阻塞性肺疾病患者心脏瓣膜置换术术后进行呼吸道管理后,患者的心肺功能得到了明显的改善,预后良好,具有较高的临床意义。

Objective To explore the clinical significance of airway management in patients with chronic obstructive disease after cardiac valve replacement.Methods The 2009 March to November 2013 period in our hospital received the treatment of 43 patients underwent cardiac valve replacement COPD patients were randomly divided into observation group and control group. The control group of 21 cases of patients given routine drug treatment, the observation group (22 cases) patients after operation on the basis of conventional drug treatment increased airway management. Compared the differences of cardiac and pulmonary function indexes between the two groups after the operation, the cumulative survival rate of two groups after operation and the related risk factors of death after discharge were compared between the 2 groups.Results Postoperative treatment ob-servation group and control group patients with heart and lung function index numerical differences were statistically significant; using logistic multivariate stepwise regression analysis method to analyze two groups of patients after two deaths related risk factors, the analysis found age is more than or equal to 70 years of age, class IV heart function and complications of patients in two groups after death related risk factors.Conclusion Pulmonary function in patients with chronic obstructive pulmonary dis-ease after heart valve replacement surgery, the patient's heart and lung function has been significantly improved, the prognosis is good and the survival rate is improved, with a high clinical significance.