Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery
Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery
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DOI：
10.1016/j.ejcts.2003.11.034
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发表时间：
2004-04-01
影响因子：
3.4
通讯作者：
Alfieri, O
中科院分区：
文献类型：
--
作者：
Pappalardo, F;Franco, A;Alfieri, O
目的：研究需要长时间（大于或等于7天）机械通气（MV）的心脏手术后并发术后病程患者的长期生存率和生活质量，因为这些患者对医院资源构成沉重负担，且其结局从未得到充分评价。研究方法：在4827例连续心脏手术患者中，148例（3%）需要延长术后MV：分析了他们的住院过程，并使用多变量分析确定了影响MV延长和死亡率的因素。采用考克斯比例风险法评估长期生存率。收集长期（36 +/- 12个月）随访信息，并通过特别问卷评估生活质量。结果：研究组的总死亡率为45.3%，对照组为2%（P < 0.0001）。长期MV组的死亡预测因素是年龄（优势比，OR 1.049）和糖尿病（OR 3.459）。21天后拔管的患者的长期生存率明显更差：1年时为88.9% vs 70.9%（P = 0.03），5年时为80.9% vs 64.5%（P = 0.05）。69%的幸存者日常生活轻度或无限制。结论：需要延长MV的患者的住院死亡率较高。21天后脱离MV的患者的长期生存率明显较低。绝大多数幸存者都能过上高质量的生活。(C)2003 Elsevier B. V.保留所有权利。
Objectives: To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (greater than or equal to 7 days) mechanical ventilation (MV), since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated. Methods: Out of 4827 consecutive cardiac surgical patients, 148 (3%) required prolonged postoperative MV: their hospital course was analysed and factors affecting prolonged MV and mortality were identified using multivariate analysis. Long-term survival was assessed using Cox proportional hazard method. Long-term (36 +/- 12 months) follow-up information was collected and quality of life was assessed by an ad hoc questionnaire. Results: Overall mortality in the study group was 45.3 versus 2% in the control population (P < 0.0001). Predictors of death in the prolonged MV group were age (odds ratio, OR 1.049) and diabetes (OR 3.459). Long-term survival was significantly worse in those patients who were extubated after 21 days: 88.9 versus 70.9% at 1 year (P = 0.03) and 80.9 versus 64.5% at 5 years (P = 0.05). Mild or no limitation in daily living was referred by 69% of the survivors. Conclusions: The hospital mortality of patients requiring prolonged MV is high. The long-term survival of patients who are weaned from MV after 21 days is significantly lower. The great majority of the survivors can enjoy a good quality of life. (C) 2003 Elsevier B.V. All rights reserved.