Gumus Funda, Polat Adil, Yektas Abdulkadir, Totoz Tolga, Bagci Murat, Erentug Vedat, Alagol Aysin
Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Bagcilar Research and Training Hospital, Istanbul, Turkey.
J Cardiothorac Vasc Anesth. 2015 Feb;29(1):52-8. doi: 10.1053/j.jvca.2014.09.002.
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.
Retrospective.
Research and training hospital, single institution.
The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients.
The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis.
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% v 41.8%; 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%).
Postoperative prolonged ventilation is associated with advanced NYHA class, chronic renal dysfunction and longer perfusion times in CABG patients.
冠状动脉旁路移植术（CABG）后长时间通气（PV）是一种常见的术后并发症。评估术前和手术参数，以确定冠状动脉旁路移植术（CABG）患者术后有长时间通气风险的患者。
回顾性研究。
研究和培训医院，单一机构。
作者分析了830例非体外循环和体外循环冠状动脉搭桥患者的前瞻性收集数据。
采用逻辑回归分析评估PV（>24小时）与术前和手术参数的关系。
46例患者（5.6%）术后需要长时间通气。该组患者的医院死亡率显著更高（45.7%对4.0%；p = 0.0001）。单因素分析显示，这些患者年龄更大（65.6±9.3对60.4±9.9；p = 0.001），脑血管疾病发生率更高（21.7%对10.5%；p = 0.032），美国麻醉医师协会（ASA）分级更高（58.7%对41.8%；p = 0.026）和纽约心脏协会（NYHA）分级更高（32.6%对12.2%；p = 0.001），以及慢性肾功能不全（20.0%对4.0%；p = 0.0001）。这些患者更常进行同期手术（30.4%对7.8%；p = 0.0001），灌注总时长更长（147.2±69.1对95.7±33.9分钟；p = 0.0001）。回归分析显示，NYHA分级更高（比值比 = 8.2；95%置信区间 = 1.5 - 43.5；p = 0.015）、慢性肾功能不全（比值比 = 7.7；95%置信区间 = 1.3 - 47.6；p = 0.027）和灌注时长更长（p = 0.012）与脱机延迟独立相关。体外循环时间超过82.5分钟每增加1分钟，拔管延迟风险增加3.5%（95%置信区间 = 0.8% - 6.4%）。
CABG患者术后长时间通气与NYHA分级更高、慢性肾功能不全和灌注时间更长有关。
