5123例心脏手术患者队列中机械通气时间延长的预测因素

Predictors of prolonged mechanical ventilation in a cohort of 5123 cardiac surgical patients.

作者信息

Cislaghi Francesca, Condemi Anna Maria, Corona Alberto

机构信息

Cardiac Anaesthetic Department, Azienda Ospedaliera Luigi Sacco, Milano-Polo Universitario, Milan, Italy.

出版信息

Eur J Anaesthesiol. 2009 May;26(5):396-403. doi: 10.1097/EJA.0b013e3283232c69.

DOI:10.1097/EJA.0b013e3283232c69

PMID:19276979

Abstract

BACKGROUND

Prolonged mechanical ventilation (PMV) after heart surgery is associated with increased patient morbidity and mortality.

METHODS

In this prospective observational cohort study the aim was to assess PMV predictors and its impact on ICU, hospital length of stay and survival in cardiac surgical patients admitted to our eight-bed ICU from January 2000 to December 2006. All perioperative patient variables were put into an electronic database. Five thousand one hundred and twenty-three patients were divided into two cohorts: early extubation, undergoing a successful extubation for 12 h or less, and delayed extubation, needing a mechanical ventilation for more than 12 h.

RESULTS

A logistic regression model identified the following as PMV predictors: age more than 65 years [odds ratio (OR), 1.296; 95% confidence interval (CI), 1.017-1.069; P = 0.016], chronic renal failure (OR, 1.571; 95% CI, 1.566-2.466; P = 0.011), chronic obstructive pulmonary disease (OR, 1.453; 95% CI, 1.695-2.454; P = 0.006), redo surgery (OR, 2.010; 95% CI, 1.389- 2.114; P = 0.001), emergency surgery (OR, 1.622; 95% CI, 1.515-2.494; P = 0.016), New York Heart Association/Canadian Cardiovascular Society class higher than 2 (OR, 1.491; 95% CI, 1.704-2.321; P = 0.001), left ventricular ejection fraction of 30% or less (OR, 2.125; 95% CI, 1.379-1.991; P = 0.000), red blood cell (OR, 5.430; 95% CI, 3.636-8.130; P = 0.000) and fresh frozen plasma transfusion units more than four (OR, 3.019; 95% CI, 1.808-5.050; P = 0.000) and cardiopulmonary bypass time more than 77 min (OR, 2.030; 95% CI, 1.248-2.174; P = 0.002). Early extubation group patients showed a higher probability of being discharged from ICU to cardiac surgical ward (log-rank = 1108.951; P = 0.000) and from cardiac to rehabilitation ward (log-rank = 598.005; P = 0.000) and higher hospital survival (log-rank = 53.215; P = 0.000).

CONCLUSION

This review allowed us to assess predictors, helping us to identify 'a priori' patients more likely to undergo PMV.

摘要

背景

心脏手术后长时间机械通气（PMV）与患者发病率和死亡率增加相关。

方法

在这项前瞻性观察性队列研究中，目的是评估2000年1月至2006年12月入住我们八张床位重症监护病房（ICU）的心脏手术患者的PMV预测因素及其对ICU、住院时间和生存率的影响。所有围手术期患者变量都录入电子数据库。5123例患者被分为两个队列：早期拔管，成功拔管时间为12小时或更短；延迟拔管，需要机械通气超过12小时。

结果

逻辑回归模型确定以下因素为PMV预测因素：年龄超过65岁[比值比（OR），1.296；95%置信区间（CI），1.017 - 1.069；P = 0.016]、慢性肾衰竭（OR，1.571；95% CI，1.566 - 2.466；P = 0.011）、慢性阻塞性肺疾病（OR，1.453；95% CI，1.695 - 2.454；P = 0.006）、再次手术（OR，2.010；95% CI，1.389 - 2.114；P = 0.001）、急诊手术（OR，1.622；95% CI，1.515 - 2.494；P = 0.016）、纽约心脏协会/加拿大心血管学会分级高于2级（OR，1.491；95% CI，1.704 - 2.321；P = 0.001）、左心室射血分数30%或更低（OR，2.125；95% CI，1.379 - 1.991；P = 0.000）、红细胞（OR，5.430；95% CI，3.636 - 8.130；P = 0.000）和新鲜冰冻血浆输注单位超过4个（OR，3.019；95% CI，1.808 - 5.050；P = 0.000）以及体外循环时间超过77分钟（OR，2.030；95% CI，1.248 - 2.174；P = 0.002）。早期拔管组患者从ICU出院到心脏外科病房（对数秩检验=1108.951；P = 0.000）以及从心脏外科病房出院到康复病房（对数秩检验=598.005；P = 0.000）的概率更高，且医院生存率更高（对数秩检验=53.215；P = 0.000）。