Kermani Mahdieh Sharifzadeh, Dehesh Tania, Pouradeli Shiva, Esmaili Bahareh Soltani
Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran.
Modeling in Health Research Center, Institue for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
J Cardiothorac Surg. 2025 Jan 29;20(1):104. doi: 10.1186/s13019-024-03247-z.
This study aimed to investigate the major predictive factors associated with prolonged mechanical ventilation(PMV) following cardiac surgery.
This retrospective, cross-sectional, descriptive-analytical study was conducted from September 2021 to March 2022, involving 244 patients who underwent cardiac surgery. PMV was defined as mechanical ventilation for more than 24 h. Potential risk factors before, during, and after surgery were examined and recorded. Logistic regression analysis was performed to assess the relationship between demographic, clinical variables, and prolonged mechanical ventilation. A significance level of 0.05 was used for data analysis.
The study population consisted of 68.4% male and 31.6% female patients, with 86.9% undergoing CABG surgery. PMV was observed in 13.1% of the patients. The findings revealed that the incidence of postoperative pneumonia increased the likelihood of PMV by more than 7 times [OR = 7.24, 95% CI=(5.12,8.14), P-value = 0.001]. Similarly, respiratory failure was associated with a 7.5-fold increase in the odds of PMV [OR = 7.56, 95% CI=(4.48,8.77), P-value = 0.042]. Drainage of one liter of blood on the first postoperative day increased the risk of PMV by 2.2 times [OR = 2.21, 95% CI=(1.98,2.46), P-value = 0.032], and the use of epinephrine was associated with a 2.73-fold increase in the odds [OR = 2.73, 95% CI=(2.24,3.11), P-value = 0.022]. Risk of PMV in the patients who had cardiac dysfunctin increased by more than 2 times.[OR = 2.58, 95%; CI = (1.33.2.87); P-value = 0.042]. In the patients need an Intra Aortic Balloon Pump(IABP) risk of PMV increased by more than 2 times. (OR = 2.74,95%,CI = 1.36,5.47: Pvalue = 0.03). The risk of PMV in the patients who had cerebrovascular accident(CVA) increased by more than three times [OR = 3.75, 95% CI = 1.26,4.84; P-value = 0.044]. For each unit increase in Euro Score 2 the chance of PMV increased by 1.38 TIMES. Furthermore ICU Mortality had a significant relationship with PMV.(Pvalue < 0.001).
The study identified postoperative complications, such as pneumonia, respiratory failure, high drainage, need to an IABP, higher EURO Score 2, Cardiac dysfunction, CVA and the use of epinephrine, as independent risk factors for PMV following cardiac surgery.
本研究旨在调查心脏手术后与机械通气时间延长（PMV）相关的主要预测因素。
本回顾性、横断面、描述性分析研究于2021年9月至2022年3月进行，纳入244例接受心脏手术的患者。PMV定义为机械通气超过24小时。对手术前、手术期间和手术后的潜在风险因素进行检查并记录。进行逻辑回归分析以评估人口统计学、临床变量与机械通气时间延长之间的关系。数据分析采用0.05的显著性水平。
研究人群中男性占68.4%，女性占31.6%，86.9%的患者接受冠状动脉旁路移植术（CABG）手术。13.1%的患者出现PMV。研究结果显示，术后肺炎的发生率使PMV的可能性增加了7倍多[比值比（OR）=7.24，95%置信区间（CI）=(5.12,8.14)，P值=0.001]。同样，呼吸衰竭与PMV的几率增加7.5倍相关[OR=7.56，95%CI=(4.48,8.77)，P值=0.042]。术后第一天引流1升血液使PMV的风险增加2.2倍[OR=2.21，95%CI=(1.98,2.46)，P值=0.032]，使用肾上腺素与几率增加2.73倍相关[OR=2.73，95%CI=(2.24,3.11)，P值=0.022]。心脏功能不全患者发生PMV的风险增加了2倍多[OR=2.58，95%；CI=(1.33,2.87)；P值=0.042]。需要主动脉内球囊反搏（IABP）的患者发生PMV的风险增加了2倍多。（OR=2.74，95%，CI=1.36,5.47：P值=0.03）。发生脑血管意外（CVA）的患者发生PMV的风险增加了3倍多[OR=3.75，95%CI=1.26,4.84；P值=0.044]。欧洲心脏手术风险评估系统（Euro Score）2每增加一个单位，PMV的几率增加1.38倍。此外，重症监护病房（ICU）死亡率与PMV有显著关系。（P值<0.001）
该研究确定术后并发症，如肺炎、呼吸衰竭、大量引流、需要IABP、较高的欧洲心脏手术风险评估系统2评分、心脏功能不全、CVA以及使用肾上腺素，是心脏手术后PMV的独立风险因素。
