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接受心脏手术患者的再次插管:一项回顾性分析。

Reintubation of patients submitted to cardiac surgery: a retrospective analysis.

作者信息

Shoji Cíntia Yukie, Figuereido Luciana Castilho de, Calixtre Eveline Maria, Rodrigues Cristiane Delgado Alves, Falcão Antonio Luis Eiras, Martins Pedro Paulo, Anjos Ana Paula Ragonete Dos, Dragosavac Desanka

机构信息

Departamento de Cirurgia, Universidade Estadual de Campinas - Campinas (SP), Brasil.

出版信息

Rev Bras Ter Intensiva. 2017 Apr-Jun;29(2):180-187. doi: 10.5935/0103-507X.20170028.

Abstract

OBJECTIVES

To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.

METHODS

Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.

RESULTS

The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).

CONCLUSION

The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

摘要

目的

分析心脏手术后需要再次气管插管的患者,并确定与死亡相关的因素及其与严重程度评分的关系。

方法

回顾性分析2007年至2015年期间1640例心脏手术后患者的信息。

结果

再次插管率为7.26%。在再次插管的患者中,36例(30.3%)接受了冠状动脉搭桥手术,27例(22.7%)接受了瓣膜置换术,25例(21.0%)接受了动脉瘤矫正术,8例(6.7%)接受了心脏移植。在合并症患者中,54例(51.9%)为高血压患者,22例(21.2%)为糖尿病患者,10例(9.6%)患有肺部疾病。在有并发症的患者中,61例(52.6%)患有肺炎,50例(42.4%)出现肾衰竭,49例(51.0%)有中度形式的气体交换短暂紊乱。53例(44.5%)患者进行了无创通气。死亡率为40.3%,在再次插管前未接受无创通气的组中死亡率更高(53.5%)。在死亡的再次插管患者中,序贯器官衰竭评估(SOFA)和急性生理与慢性健康状况评分系统II(APACHE II)值分别为7.9±3.0和16.9±4.5。大多数再次插管患者(47.5%)属于高危组,欧洲心脏手术风险评估系统(EuroSCORE)(>6分)。

结论

再次插管率较高,且与较差的SOFA、APACHE II和EuroSCORE评分相关。在再次插管前未接受无创通气的组中死亡率更高。

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