Doering L V, Imperial-Perez F, Monsein S, Esmailian F
University of California School of Nursing, USA.
Am J Crit Care. 1998 Jan;7(1):37-44.
To identify preoperative, intraoperative, and postoperative predictors of early (6 hours or less after surgery) and delayed (more than 6 hours) extubation after coronary artery bypass graft surgery.
The sample for this prospective nonrandomized study consisted of 116 consecutive patients in a 12-bed cardiothoracic ICU who had coronary artery bypass graft surgery in a 6-month period and were followed up prospectively until transfer to an observation unit.
Age and the presence of early hemodynamic instability (within the first 3 hours after ICU admission) were independent predictors of intubation times of more than 6 hours when each was considered in separate multivariate models of preoperative, intraoperative, and postoperative variables. In a combined model, when considered with age and ejection fraction, the presence of early hemodynamic instability increased the odds by 4.7 times that extubation would occur more than 6 hours after surgery. For every 1 year increase in age, the odds of extubation occurring more than 6 hours after surgery increased by 6.5%.
Older age and the presence of early hemodynamic instability are associated with postoperative intubation periods of more than 6 hours after coronary artery bypass graft surgery. Clinicians should evaluate extubation goals in older patients carefully. Clinical management of hemodynamic instability should be aimed at prompt optimization of myocardial oxygen supply to limit ischemia and its sequelae.
确定冠状动脉搭桥手术后早期（术后6小时或更短时间）和延迟（超过6小时）拔管的术前、术中和术后预测因素。
这项前瞻性非随机研究的样本包括12张床位的心胸重症监护病房（ICU）中连续116例患者，这些患者在6个月内接受了冠状动脉搭桥手术，并进行前瞻性随访直至转至观察病房。
在术前、术中和术后变量的单独多变量模型中，年龄和早期血流动力学不稳定（入住ICU后3小时内）的存在分别是插管时间超过6小时的独立预测因素。在一个综合模型中，当与年龄和射血分数一起考虑时，早期血流动力学不稳定的存在使术后超过6小时拔管的几率增加了4.7倍。年龄每增加1岁，术后超过6小时拔管的几率增加6.5%。
年龄较大和早期血流动力学不稳定与冠状动脉搭桥手术后超过6小时的术后插管时间有关。临床医生应仔细评估老年患者的拔管目标。血流动力学不稳定的临床管理应旨在迅速优化心肌氧供应，以限制缺血及其后遗症。
