Légaré J F, Hirsch G M, Buth K J, MacDougall C, Sullivan J A
Dalhousie University, Halifax, Nova Scotia, Canada.
Eur J Cardiothorac Surg. 2001 Nov;20(5):930-6. doi: 10.1016/s1010-7940(01)00940-x.
Few studies have attempted to evaluate who would require prolonged mechanical ventilation following heart surgery. The objectives of this study were to identify predictors of prolonged ventilation in a large group of coronary artery bypass grafting (CABG) patients from a single institution.
One thousand, eight hundred and twenty-nine consecutive patients undergoing CABG were reviewed retrospectively and evaluated for preoperative predictors of prolonged ventilation which included: age, gender, ejection fraction (EF), renal function, diabetes, angina status, New York Heart Association Class, number of diseased vessels, urgency of the procedure, re-operation, chronic lung disease (COPD) and intraoperative variables such as IABP, inotropes, stroke and myocardial infarction. Prolonged ventilation was defined as > or = 24 h. Stepwise logistic regression analysis was performed.
Patients were on average 65.4+/-10.6 years of age, 30% were diabetic, 80% had triple vessel disease and 93% were of functional class III/IV. The mean ejection fraction was 60+/-16 percent. Overall peri-operative mortality was 2.7%. There were 157 patients that required prolonged ventilation with a peri-operative mortality of 18.5% (P < 0.001). Preoperative independent predictors of prolonged ventilation were found to be: unstable angina (OR 5.6), EF < 50 (OR 2.3), COPD (OR 2.0), preop. renal failure (OR 1.9), female gender (OR 1.8) and age > 70 (OR 1.7). Based on these predictors, a model was created to estimate of the risk of prolonged ventilation in individual patients following CABG with results ranging from < or = 3% in patients without any risk factors to > or = 32% in patients with five or more independent risk factors. Certain intraoperative variables were strong predictors of prolonged ventilation and included: stroke (OR 12.3), re-operation for bleeding (OR 6.9) and perioperative MI (OR 5.8).
We were able to create a stable model where several preoperative and intra-operative variables were shown to be predictive of prolonged ventilation after CABG surgery. The ability to identify patients at increased risk for prolonged ventilation may allow the development of pre-emptive strategies and more effective resource allocation.
很少有研究试图评估心脏手术后哪些患者需要长时间机械通气。本研究的目的是在来自单一机构的一大组冠状动脉旁路移植术（CABG）患者中确定长时间通气的预测因素。
回顾性分析1829例连续接受CABG的患者，并评估长时间通气的术前预测因素，包括：年龄、性别、射血分数（EF）、肾功能、糖尿病、心绞痛状态、纽约心脏协会分级、病变血管数量、手术紧急程度、再次手术、慢性肺病（COPD）以及术中变量，如主动脉内球囊反搏（IABP）、血管活性药物、中风和心肌梗死。长时间通气定义为≥24小时。进行逐步逻辑回归分析。
患者平均年龄为65.4±10.6岁，30%患有糖尿病，80%有三支血管病变，93%为功能分级III/IV级。平均射血分数为60±16%。围手术期总体死亡率为2.7%。有157例患者需要长时间通气，围手术期死亡率为18.5%（P<0.001）。发现长时间通气的术前独立预测因素为：不稳定型心绞痛（比值比[OR]5.6）、EF<50（OR 2.3）、COPD（OR 2.0）、术前肾衰竭（OR 1.9）、女性（OR 1.8）和年龄>70岁（OR 1.7）。基于这些预测因素，创建了一个模型来估计CABG术后个体患者长时间通气的风险，结果显示，无任何风险因素的患者风险<或=3%，有五个或更多独立风险因素的患者风险>或=32%。某些术中变量是长时间通气的强预测因素，包括：中风（OR 12.3）、因出血再次手术（OR 6.9）和围手术期心肌梗死（OR 5.8）。
我们能够创建一个稳定的模型，其中几个术前和术中变量被证明可预测CABG手术后的长时间通气。识别长时间通气风险增加的患者的能力可能有助于制定先发制人的策略和更有效的资源分配。
