Prolonged Mechanical Ventilation After CABG: Risk Factor Analysis
Prolonged Mechanical Ventilation After CABG: Risk Factor Analysis
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DOI：
10.1053/j.jvca.2014.09.002
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发表时间：
2015-02-01
影响因子：
2.8
通讯作者：
Alagol, Aysin
中科院分区：
文献类型：
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作者：
Gumus, Funda;Polat, Adil;Alagol, Aysin
目的：冠状动脉旁路移植术（CABG）后通气时间延长是一种常见的术后并发症。术前和手术参数进行了评估，以确定患者在冠状动脉旁路移植术（CABG）患者术后长期通气的风险。设计：回顾性。设置：研究和培训医院，单一机构。参与者：作者分析了前瞻性收集的830例体外循环和非体外循环冠状动脉旁路移植术患者的数据。干预措施：PV（>24小时）与术前和手术参数的关系进行了评估与logistic回归analysis. Measures和主要结果：46例患者（5.6%）需要PV术后。该组的住院死亡率显著更高（45.7% vs 4.0%; p = 0.0001）。单因素分析显示，这些患者年龄较大，（65.6 +/- 9.3 v60.4 +/- 9.9; p = 0.001），脑血管疾病的发生率更高（21.7% v10.5%; p = 0.032）、晚期阿萨（58.7% v41.8%; p = 0.026）和NYHA分级（32.6% v12.2%; p = 0.001）和慢性肾功能不全（20.0% v4.0%; p = 0.0001）。这些患者更常进行伴随手术（30.4% vs 7.8%; p = 0.0001），总灌注持续时间更长（147.2 +/- 69.1 vs 95.7 +/- 33.9分钟; p = 0.0001）。在回归分析中，发现高级NYHA分级（比值比= 8.2; 95% CI = 1.5-43.5; p = 0.015）、慢性肾功能不全（比值比= 7.7; 95% CI = 1.3-47.6; p = 0.027）和较长的灌注持续时间（p = 0.012）与延迟撤机独立相关。体外循环时间超过82.5分钟，每增加1分钟，延迟拔管的风险增加3.5%（95%CI = 0.8%~ 6.4%.Conclusions：CABG患者术后延长通气时间与NYHA分级、慢性肾功能不全和灌注时间延长有关。(C)2014爱思唯尔公司All rights reserved.
Objective: Prolonged ventilation (PV) after coronary artery bypass graft (CABG) surgery is a common postoperative complication. Preoperative and operative parameters were evaluated in order to identify the patients at risk for prolonged ventilation postoperatively in coronary artery bypass graft (CABG) patients.Design: Retrospective.Setting: Research and training hospital, single institution.Participants: The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients.Interventions: The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis.Measurements and Main Results: Forty-six patients (5.6%) required PV postoperatively. Hospital mortality was significantly higher in this group (45.7% v 4.0%; p = 0.0001). Univariate analysis showed that these patients were older (65.6 +/- 9.3 v 60.4 +/- 9.9; p = 0.001), had higher incidences of cerebrovascular disease (21.7% v 10.5%; p = 0.032), advanced ASA (58.7% v41.8%; p = 0.026) and NYHA classes (32.6% v 12.2%; p = 0.001), and chronic renal dysfunction (20.0% v 4.0%; p = 0.0001). Concomitant procedures were more commonly performed in these patients (30.4% v 7.8%; p = 0.0001), and total durations of perfusion were longer (147.2 +/- 69.1 v 95.7 +/- 33.9 minutes; p = 0.0001). In regression analysis, advanced NYHA class (odds ratio = 8.2; 95% CI = 1.5-43.5; p = 0.015), chronic renal dysfunction (odds ratio = 7.7; 95% CI = 1.3-47.6; p = 0.027), and longer perfusion durations (p = 0.012) were found to be independently associated with delayed weaning from the ventilator. Every 1-minute increase over 82.5 minutes of cardiopulmonary bypass increased risk of delayed extubation by 3.5% (95% CI = 0.8%-6.4%).Conclusions: Postoperative prolonged ventilation is associated with advanced NYHA class, chronic renal dysfunction and longer perfusion times in CABG patients. (C) 2014 Elsevier Inc. All rights reserved.