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| 低出生体重患儿开胸心脏术后机械通气时间延长的危险因素分析 |
| Risk factors of prolonged mechanical ventilation in low birth weight infants undergoing congenital heart surgery |
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| DOI：10.12089/jca.2019.06.002 |
| 中文关键词: 机械通气 先天性心脏病 危险因素 低出生体重 心脏外科 |
| 英文关键词: Mechanical ventilation Congenital heart disease Risk factor Low birth weight Cardiac surgery |
| 基金项目:广东省自然科学基金（2018A030313535） |
| 作者 | 单位 | E-mail | | 鲁超 | 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 | | | 韦锦锋 | 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 | | | 陈寄梅 | 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 | | | 庄建 | 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 | | | 王晟 | 510080,广州市,广东省心血管病研究所,广东省人民医院,广东省医学科学院麻醉科 | shengwang_gz@163.com |
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| 中文摘要: |
目的 分析低出生体重患儿开胸心脏术后机械通气时间延长的危险因素。
方法 选择2003年6月至2018年3月在本院行开胸心脏手术的低出生体重（≤2.5 kg）患儿121例，男80例，女41例，手术日龄3~84 d，出生体重1.05~2.50 kg，手术日体重1.13~2.70 kg，ASA Ⅲ或Ⅳ级。根据术后机械通气时间分为两组：机械通气＞7 d的延长组（PMV组，n=40）和≤7 d的非延长组（N-PMV组，n=81）。收集两组患儿一般情况和术前、术中和术后资料，采用单因素相关分析和二元逐步Logistic回归分析观察影响机械通气时间延长的危险因素。
结果 与N-PMV组比较，PMV组深低温停循环时间明显延长（P<0.05），术前机械通气、术后延迟关胸、再次气管插管、非计划再次手术明显增多（P<0.05），术后24 h乳酸浓度最大值明显升高（P<0.05），术后贫血、术后败血症明显增多（P<0.05）。二元逐步Logistic回归分析显示，术后败血症（OR=26.511，95%CI 1.326~530.217，P=0.032）和术后延迟关胸（OR=6.573，95%CI 1.293~33.401，P=0.023）是低出生体重患儿开胸心脏术后机械通气时间延长的独立危险因素。
结论 低出生体重患儿开胸心脏术后造成机械通气时间延长的原因较多，术后败血症和延迟关胸是机械通气时间延长的独立危险因素。 |
| 英文摘要: |
Ojective To analyze the risk factors of prolonged mechanical ventilation （PMV）in low birth weight (LBW) infants undergoing congenital heart surgery.
Methods From June 2003 to March 2018, medical records of 121 infants with LBW (≤ 2.5 kg) undergoing congenital heart surgery were reviewed. There were 80 males and 41 females in ASA physical status Ⅲ or Ⅳ, the age at surgery was 3 - 84 days, the birth weight was 1.05 --2.50 kg and the operation weight was 1.13 - 2.70 kg. The data was divided into two groups depending on whether the postoperative mechanical ventilation time was > 7 days: group PMV (> 7 days) and group N-PMV (≤ 7 days). There were 40 infants in group PMV, and 81 infants in group NPMV. General information, preoperative, intraoperative and postoperative data of the two groups of infants were collected. Postoperative mechanical ventilation time was elicited by means of univariate and stepwise logistic regression analysis.
Results The univariate analysis showed that deep hypothermic circulatory arrest time, preoperative mechanical ventilation, postoperative endotracheal re-intubation, delayed sternal closure, non planned re-operation, postoperative maximum lactic acid concentration within 24 hours, postoperative anemia and postoperative septicemia had significant relations with prolonged mechanical ventilation （P < 0.05）. Futher stepwise logistic regression showed that postoperative septicemia (OR = 26.511, 95% CI 1.326 - 530.217, P = 0.032) and delayed sternal closure (OR = 6.573, 95% CI 1.293 - 33.401, P = 0.023) were independent risk factors for prolonged mechanical ventilation.
Conclusion There are many reasons for PMV in LBW infants undergoing congenital heart surgery. Postoperative septicemia and delayed sternal closure are independent risk factors for prolonged mechanical ventilation. |
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