Lin Xuefeng, Wang Funan, Wang Yuting
Department of Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, 361015 Xiamen, Fujian, China.
Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 361015 Xiamen, Fujian, China.
Rev Cardiovasc Med. 2024 Oct 28;25(10):387. doi: 10.31083/j.rcm2510387. eCollection 2024 Oct.
Delayed extubation with mechanical ventilation after cardiac valve surgery is an important clinical challenge. Early extubation can improve the survival rate and prognosis of patients. The study aims to explore the predictive value of a chest X-ray pulmonary edema imaging score on the first day after surgery for delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass.
Retrospective analysis of the clinical data of patients undergoing cardiac valve surgery under extracorporeal circulation admitted to the intensive care unit of Zhongshan Hospital Affiliated with Fudan University (Xiamen) from January 2020 to October 2023. The patients were divided into an early extubation group according to the postoperative mechanical ventilation time (time: <24 h) and a delayed extubation group (time: ≥24 h). The radiographic assessment of lung edema (RALE) score was performed on the chest X-ray of the patient on the first day after surgery to analyze the correlation between delayed extubation of mechanical ventilation and the chest radiograph RALE score on the first day after surgery and to verify its predictive performance.
Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, PCO, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation ( = 0.013, 0.001, 0.034, <0.001, <0.001, <0.001, <0.001, <0.001, 0.014, and <0.001, respectively). No significant differences were observed in the proportion of males and the lactate level after the first 24 h between the two groups ( = 0.792 and 0.191, respectively). The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant ( < 0.001). Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively.
The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value.
心脏瓣膜手术后机械通气延迟拔管是一项重要的临床挑战。早期拔管可提高患者的生存率和预后。本研究旨在探讨体外循环心脏瓣膜手术后患者术后第1天胸部X线肺水肿影像评分对延迟拔管的预测价值。
回顾性分析2020年1月至2023年10月在复旦大学附属中山医院（厦门）重症监护病房接受体外循环心脏瓣膜手术患者的临床资料。根据术后机械通气时间将患者分为早期拔管组（时间：<24小时）和延迟拔管组（时间：≥24小时）。对术后第1天患者的胸部X线进行肺水肿放射学评估（RALE）评分，分析机械通气延迟拔管与术后第1天胸部X线RALE评分之间的相关性，并验证其预测性能。
术前和术后24小时内拔管患者之间在年龄、高血压发病率、体重指数（BMI）、左心室射血分数（LVEF）、体外循环时间、RALE评分、通气时间、氧合指数、PCO₂和脑钠肽（BNP）水平方面存在显著差异（分别为P = 0.013、0.001、0.034、<0.001、<0.001、<0.001、<0.001、<0.001、0.014和<0.001）。两组之间在男性比例和术后24小时乳酸水平方面未观察到显著差异（分别为P = 0.792和0.191）。所有患者的机械通气时间与RALE评分呈正相关，相关系数为0.419；差异具有统计学意义（P < 0.001）。对各研究因素进行逐步回归的多变量二元逻辑回归分析，发现RALE评分、体外循环时间、氧合指数和术后BNP是体外循环心脏手术患者延迟拔管的独立危险因素。十折交叉验证显示，回归模型的平均准确率（accuracy）、敏感性（sensitivity）、特异性（specificity）和曲线下面积（AUC）分别为0.737、0.749、0.741和0.825。
术后第1天胸部X线的RALE评分是体外循环心脏瓣膜手术后患者延迟拔管的独立危险因素，具有良好的预测价值。
