Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiothorac Vasc Anesth. 2020 Apr;34(4):940-948. doi: 10.1053/j.jvca.2019.10.043. Epub 2019 Nov 2.
Prolonged mechanical ventilation (PMV) is closely associated with higher morbidity and mortality after total cavopulmonary surgery. The aim of the present study was to identify the clinical risk factors for PMV.
A retrospective case-control study.
Fuwai Hospital.
The study comprised 504 patients who underwent total cavopulmonary surgery from 2010 to 2018.
None.
The definition of PMV was derived from the Cox regression model for predicting postoperative length of hospital stay. Least absolute shrinkage and selection operator regression, logistic regression, and Cox regression were applied to identify predictors for PMV. Patients with mechanical ventilation time >9 hours were identified as having PMV. Independent predictors of PMV included age, intraoperative maximum vasoactive-inotropic score, minimal temperature during cardiopulmonary bypass, postoperative prothrombin time, alkaline phosphatase and total bilirubin levels, and postoperative fluid balance. These predictors also were achieved in the Cox regression for predicting the duration of mechanical ventilation. Patients with PMV were associated with increased blood transfusions, more consumption of vasopressin and antipulmonary hypertension medication, higher incidence of reintubation, more renal replacement treatment, longer intensive care unit stay, greater hospitalization costs, and more specialist visits.
Age at surgery, maximal vasoactive-inotropic score and minimal temperature during cardiopulmonary bypass, postoperative prothrombin time, alkaline phosphatase and total bilirubin levels, and postoperative fluid balance were demonstrated to be independent predictors of PMV. Adopting a comprehensive strategy of perioperative management that targets the identified risk factors might significantly lower the risk of PMV and improve in-hospital outcomes, and furthermore, patients with PMV might need more specialist visits.
全腔静脉肺动脉连接术后，长时间机械通气（PMV）与较高的发病率和死亡率密切相关。本研究旨在确定 PMV 的临床危险因素。
回顾性病例对照研究。
阜外医院。
本研究纳入 2010 年至 2018 年期间行全腔静脉肺动脉连接术的 504 例患者。
无。
PMV 的定义来源于预测术后住院时间的 Cox 回归模型。应用最小绝对收缩和选择算子回归、逻辑回归和 Cox 回归来确定 PMV 的预测因素。机械通气时间>9 小时的患者被定义为 PMV。PMV 的独立预测因素包括年龄、术中最大血管活性-正性肌力评分、体外循环期间最低体温、术后凝血酶原时间、碱性磷酸酶和总胆红素水平以及术后液体平衡。这些预测因素也在预测机械通气时间的 Cox 回归中得到了验证。PMV 患者与输血增加、血管加压素和抗肺动脉高压药物消耗增加、再插管发生率增加、更多的肾脏替代治疗、重症监护病房停留时间延长、住院费用增加和更多专科就诊有关。
手术时年龄、体外循环期间最大血管活性-正性肌力评分和最低体温、术后凝血酶原时间、碱性磷酸酶和总胆红素水平以及术后液体平衡被证明是 PMV 的独立预测因素。采用针对这些确定的危险因素的综合围手术期管理策略可能会显著降低 PMV 的风险并改善住院结局，此外，PMV 患者可能需要更多的专科就诊。
