Pappalardo Federico, Franco Annalisa, Landoni Giovanni, Cardano Paola, Zangrillo Alberto, Alfieri Ottavio
Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132 Milano, Italy.
Eur J Cardiothorac Surg. 2004 Apr;25(4):548-52. doi: 10.1016/j.ejcts.2003.11.034.
To study the long-term survival and quality of life of patients with a complicated post-operative course after cardiac surgery requiring prolonged (>or=7 days) mechanical ventilation (MV), since they represent a heavy burden on hospital resources and their outcome has never been adequately evaluated.
Out of 4827 consecutive cardiac surgical patients, 148 (3%) required prolonged post-operative 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.
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.
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.
研究心脏手术后术后病程复杂、需要长时间（≥7天）机械通气（MV）的患者的长期生存情况和生活质量，因为这类患者给医院资源带来沉重负担，且其预后从未得到充分评估。
在4827例连续的心脏手术患者中，148例（3%）需要长时间术后MV：分析他们的住院病程，并使用多变量分析确定影响长时间MV和死亡率的因素。使用Cox比例风险法评估长期生存情况。收集长期（36±12个月）随访信息，并通过一份专门设计的问卷评估生活质量。
研究组的总体死亡率为45.3%，而对照组为2%（P<0.0001）。长时间MV组的死亡预测因素为年龄（优势比，OR 1.049）和糖尿病（OR 3.459）。21天后拔管的患者长期生存情况明显更差：1年时为88.9%对70.9%（P=0.03），5年时为80.9%对64.5%（P=0.05）。69%的幸存者表示日常生活有轻度限制或无限制。
需要长时间MV的患者医院死亡率很高。21天后脱机的患者长期生存率明显较低。绝大多数幸存者能享有良好的生活质量。
