Prapas Sotirios N, Panagiotopoulos Ioannis A, Hamed Abdelsalam Ashraf, Kotsis Vasilios N, Protogeros Dimitrios A, Linardakis Ioannis N, Danou Fotini N
Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece.
Eur J Cardiothorac Surg. 2007 Sep;32(3):488-92. doi: 10.1016/j.ejcts.2007.05.025. Epub 2007 Jul 24.
To identify parameters associated with prolonged mechanical ventilation (PMV) (>48 h) after off-pump coronary artery bypass (OPCAB) in our patient population.
From February 2001 to November 2005, we operated on 1359 patients for isolated coronary revascularization with the pi-circuit technique, consisting of: (1) beating heart, (2) OPCAB, (3) aorta no-touch, (4) use of composite grafts, and (5) arterial revascularization.
From the total number of our patients, 1320 patients had been extubated within 48 h postoperatively (Group A) and 39 patients needed PMV (Group B). In our study we have found that PMV were associated with advanced age (64.74+/-9.85 Group A vs 68.43+/-10.03 Group B, p<0.02) as well as higher incidence with octogenarians (4.4% Group A vs 10.2% Group B, p=0.09). Patients with preoperative history of transient ischemic attacks (TIAs) or stroke were more likely to belong to Group B (1.5% Group A vs 7.7% Group B, p<0.02; 2.8% Group A vs 10.3% Group B, p<0.02, respectively). Preoperative intra-aortic balloon pump (IABP) insertion was associated with PMV (1.6% Group A vs 15.4% Group B, p<0.0005). Unexpectedly, neither COPD nor obesity was associated with PMV (4.9% Group A vs 7.7% Group B, p=NS, 21.7% Group A vs 23.1% Group B, p=NS, respectively).
In this study, PMV following aorta no-touch OPCAB was related to preoperative variables: age, octogenarians, preoperative IABP, TIA, and stroke. There was no relation between PMV and any of the operative data.
确定我们患者群体中，非体外循环冠状动脉搭桥术（OPCAB）后延长机械通气（PMV，>48小时）相关的参数。
2001年2月至2005年11月，我们采用π-回路技术对1359例患者进行了单纯冠状动脉血运重建手术，包括：（1）心脏跳动；（2）非体外循环冠状动脉搭桥术；（3）不触碰主动脉；（4）使用复合移植物；（5）动脉血运重建。
在我们的患者总数中，1320例患者术后48小时内拔管（A组），39例患者需要延长机械通气（B组）。在我们的研究中，我们发现延长机械通气与高龄相关（A组64.74±9.85 vs B组68.43±10.03，p<0.02），以及八旬老人的发生率更高（A组4.4% vs B组10.2%，p=0.09）。有短暂性脑缺血发作（TIA）或中风术前病史的患者更有可能属于B组（A组1.5% vs B组7.7%，p<0.02；A组2.8% vs B组10.3%，p<0.02）。术前主动脉内球囊泵（IABP）置入与延长机械通气相关（A组1.6% vs B组15.4%，p<0.0005）。出乎意料的是，慢性阻塞性肺疾病（COPD）和肥胖均与延长机械通气无关（A组4.9% vs B组7.7%，p=无统计学意义，A组21.7% vs B组23.1%，p=无统计学意义）。
在本研究中，不触碰主动脉的非体外循环冠状动脉搭桥术后的延长机械通气与术前变量有关：年龄、八旬老人、术前主动脉内球囊泵、短暂性脑缺血发作和中风。延长机械通气与任何手术数据均无关联。
