Hsu Huan, Lai Hui-Chin, Liu Tsun-Jui
Department of Anesthesiology, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Heart Vessels. 2019 Jan;34(1):44-51. doi: 10.1007/s00380-018-1221-6. Epub 2018 Jul 13.
Robot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were included. The definition of PMV was failure to wean from mechanical ventilation more than 48 h after the surgery. Risk factors for PMV, and peri-operative morbidity and mortality were analyzed with a multivariate logistic regression model. Forty-three patients (11.3%) developed PMV after the surgery, and the peri-operative morbidity and mortality rates were 38 and 2.6%, respectively. The risk factors for PMV were age, left ventricular ejection fraction (LVEF), the duration of one-lung ventilation for MIDCABG (beating time), and peak airway pressure at the end of the surgery. Furthermore, age and anesthesia time were found to be independent risk factors for peri-operative morbidity, whereas age, LVEF, and anesthesia time were the risk factors for peri-operative mortality. These findings may help physicians to properly choose patients for this procedure, and provide more attention to patients with higher risk after surgery to achieve better clinical outcomes.
机器人辅助冠状动脉旁路移植术[机器人辅助（冠状动脉旁路移植术（CABG））]是冠心病的最新治疗方法。然而，该手术对心肺功能有广泛影响，并且与围手术期发病相关的危险因素，包括延长机械通气（PMV），尚未得到充分研究。在这项回顾性队列研究中，纳入了2005年至2012年在我们的三级医疗中心接受机器人辅助胸廓内动脉采集与微创开胸直视旁路移植手术（MIDCABG）的382例患者。PMV的定义为术后机械通气超过48小时仍无法脱机。采用多因素逻辑回归模型分析PMV、围手术期发病率和死亡率的危险因素。43例患者（11.3%）术后发生PMV，围手术期发病率和死亡率分别为38%和2.6%。PMV的危险因素为年龄、左心室射血分数（LVEF）、MIDCABG单肺通气时间（跳动时间）和手术结束时的气道峰值压力。此外，年龄和麻醉时间是围手术期发病的独立危险因素，而年龄、LVEF和麻醉时间是围手术期死亡的危险因素。这些发现可能有助于医生正确选择适合该手术的患者，并对术后风险较高的患者给予更多关注，以实现更好的临床结果。
