Predictors of Prolonged Mechanical Ventilation After Aortic Arch Surgery With Deep Hypothermic Circulatory Arrest Plus Antegrade Selective Cerebral Perfusion
Predictors of Prolonged Mechanical Ventilation After Aortic Arch Surgery With Deep Hypothermic Circulatory Arrest Plus Antegrade Selective Cerebral Perfusion
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DOI：
10.1053/j.jvca.2008.09.006
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发表时间：
2009-08-01
影响因子：
2.8
通讯作者：
Li, Lihuan
中科院分区：
文献类型：
--
作者：
Lei, Qian;Chen, Lei;Li, Lihuan
目的：主动脉弓手术联合深低温停循环后长时间机械通气的预测因素尚未得到全面评价。本研究的目的是确定一组主动脉弓手术患者在一个单一的center.Design：一项回顾性研究的长期通气相关的变量。长期机械通气定义为>72小时。设置：心血管手术室和重症监护室。参与者：需要主动脉弓手术的成人，深低温停循环加顺行选择性脑灌注。干预：无。测量和主要结果：排除7例接受一期全或次全主动脉置换术的患者后，255例患者入选本研究。患者的平均年龄为44.7 ± 10.8岁，男性占多数（74.1%）。229例患者在术后72小时内拔管，26例患者需要长期机械通气。长期机械通气患者的院内死亡率、卒中和需要透析和重新插管的肾衰竭发生率较高，在重症监护室和住院时间较长（p < 0.05）。在多因素分析中，发现延长机械通气的预测因素是延长体外循环时间、高龄、急诊和术前血清肌酐水平（p < 0.05）。结论：作者确定了4个与延长机械通气风险增加相关的术前和术中预测因素。这有助于识别延长通气风险增加的患者，制定先发制人的策略，并分配医疗资源。(C)2009 Elsevier Inc. All rights reserved.
Objective: The predictors of prolonged mechanical ventilation after aortic arch surgery with deep hypothermic circulatory arrest have not been comprehensively evaluated. The present study was designed to identify variables associated with prolonged ventilation in a group of aortic arch surgery patients from a single center.Design: A retrospective study. Prolonged mechanical ventilation was defined as >72 hours.Setting: Cardiovascular operating rooms and the intensive care unit.Participants: Adults requiring aortic arch surgery with deep hypothermic circulatory arrest plus antegrade selective cerebral perfusion.Interventions: None.Measurements and Main Results: After 7 patients who underwent 1-stage total or subtotal aortic replacement were excluded, 255 patients were enrolled in the study. The average age of the patients was 44.7 +/- 10.8 years with male predominance (74.1%). Two hundred twenty-nine patients were extubated within 72 hours postoperatively, and 26 patients needed prolonged mechanical ventilation. Patients with prolonged mechanical ventilation had higher incidences of in-hospital mortality, stroke, and renal failure requiring dialysis and reintubation and stayed longer in the intensive care unit and hospital than those without prolonged ventilation (p < 0.05). In multivariate analysis, predictors of prolonged ventilation were found to be prolonged cardiopulmonary bypass time, advanced age, emergency, and preoperative serum creatinine level (p < 0.05).Conclusion: The authors identified 4 preoperative and intraoperative predictors associated with increased risk of prolonged mechanical ventilation. This is helpful to identify patients with increased risk for prolonged ventilation, develop preemptive strategies, and allocate medical resources. (C) 2009 Elsevier Inc. All rights reserved.