现行心脏瓣膜手术中需要长时间体外循环的早期拔管：术前肺功能测定的益处和预测价值。

Early extubation in current valve surgery requiring long cardiopulmonary bypass: Benefits and predictive value of preoperative spirometry.

机构信息

Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-cho Nakahara-ku, Kawasaki, Kanagawa, 211-8533 Japan.

Department of Thoracic Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-cho Nakahara-ku, Kawasaki, Kanagawa, 211-8533 Japan.

出版信息

Heart Lung. 2020 Nov-Dec;49(6):709-715. doi: 10.1016/j.hrtlng.2020.07.013. Epub 2020 Aug 28.

DOI:10.1016/j.hrtlng.2020.07.013

PMID:32861890

Abstract

BACKGROUND

Early extubation (EEx) after cardiac surgery has been essentially studied in patients with short cardiopulmonary bypass (CPB). Whether preoperative spirometry can predict EEx remains controversial.

OBJECTIVES

To investigate whether EEx can be a goal and predicted by preoperative spirometry in valve surgery requiring long CPB.

METHODS

Nonemergent consecutive 210 patients who underwent valve surgery from January 2014 to August 2019 were investigated retrospectively.

RESULTS

EEx (<8 h) was achieved in 93 (44.3%) patients without increasing adverse events. Patients with EEx had shorter ICU and hospital stays than those without EEx. Multivariate analysis showed that higher estimated glomerular filtration rate and mitral valve repair were significant protective factors for EEx. Conversely, moderate and severe chronic obstructive pulmonary disease defined by spirometry, longer operation, CPB, and aortic cross-clamp time were significant risk factors.

CONCLUSIONS

EEx should be the goal in current valve surgery. Preoperative spirometry is a significant predictor.

摘要

背景

心脏手术后早期拔管（EEx）主要在心肺转流（CPB）时间较短的患者中进行研究。术前肺活量测定能否预测 EEx 仍存在争议。

目的

探讨术前肺活量测定能否预测需要长时间 CPB 的瓣膜手术中 EEx 的目标和预测值。

方法

回顾性分析 2014 年 1 月至 2019 年 8 月期间接受瓣膜手术的 210 例非急诊连续患者。

结果

93 例（44.3%）患者实现了 EEx（<8 h），并未增加不良事件。与无 EEx 患者相比，EEx 患者 ICU 和住院时间更短。多因素分析显示，较高的估算肾小球滤过率和二尖瓣修复是 EEx 的显著保护因素。相反，由肺活量测定法定义的中度和重度慢性阻塞性肺疾病、较长的手术时间、CPB 时间和主动脉阻断时间是显著的风险因素。