本文選題：心臟瓣膜置換術(shù) + 機(jī)械通氣　； 參考：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2017年28期

【摘要】：目的探究單純瓣膜置換(HVPI)術(shù)后機(jī)械通氣時(shí)間延長(zhǎng)(PMV)的發(fā)生率、危險(xiǎn)因素以及對(duì)臨床預(yù)后的影響。方法回顧性分析該院心胸外科2013年度的HVPI的400例患者。記錄術(shù)前、術(shù)中以及術(shù)后等多種變量,進(jìn)行單因素和多因素分析。呼吸機(jī)時(shí)間延長(zhǎng)定義為術(shù)后呼吸機(jī)應(yīng)用時(shí)間24 h。結(jié)果 PMV患者87例(21.8%)。單因素分析發(fā)現(xiàn)非PMV組(A組)與PMV組(B組)患者在總膽紅素水平、心功能Ⅲ~Ⅳ級(jí)、左室舒張末徑、左室射血分?jǐn)?shù)、轉(zhuǎn)機(jī)時(shí)間、手術(shù)當(dāng)天引流量、血紅蛋白、血清肌酐、血糖、乳酸等方面,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素分析發(fā)現(xiàn)LVEF50%(OR=0.051,95%CI:0.005~0.541,P=0.014)是避免術(shù)后PMV的保護(hù)因素,而轉(zhuǎn)機(jī)時(shí)間120 min(OR=2.144,95%CI:1.061~4.335,P=0.034)、術(shù)后24 h肌酐133μmol/L(OR=2.979,95%CI:1.463~6.069,P=0.003)和乳酸5 mmol/L(OR=4.379,95%CI:2.115~9.067,P=0.000)是導(dǎo)致術(shù)后PMV的危險(xiǎn)因素。術(shù)后PMV患者組患者術(shù)后死亡率(OR=8.0,95%CI:1.4~44.3,P=0.019)和ICU2 d(OR=9.4,95%CI:5.4~16.3,P=0.000)的風(fēng)險(xiǎn)較對(duì)照組增加。結(jié)論 HVPI術(shù)后PMV與左心收縮功能、轉(zhuǎn)機(jī)時(shí)間、術(shù)后早期肌酐和乳酸水平等多因素相關(guān),PMV可導(dǎo)致術(shù)后死亡率增加和ICU滯留時(shí)間延長(zhǎng)。
[Abstract]:Objective to investigate the incidence, risk factors and clinical prognosis of prolonged mechanical ventilation (PMV) after simple valve replacement (HVPI). Methods A retrospective analysis of 400 patients with HVPI in the Department of Cardiothoracic surgery in 2013 was performed. All variables were recorded before, during and after operation, and univariate and multivariate analysis were performed. The extension of ventilator time was defined as 24 hours after operation. Results 87 patients with PMV were involved in 21. 8 cases. Univariate analysis showed that the total bilirubin level, cardiac function 鈪，

本文編號(hào)：1868147