体外循环术后患者延迟撤机的危险因素分析

为了探讨ICU内体外循环术后患者延迟撤机的危险因素，收集了2005年5月～2007年10月我院体外循环术后患者共305例，根据患者机械通气时间分为延迟撤机组（机械通气时间≥24h）和早期撤机组（机械通气时间〈24h），对患者术前基础血糖、白蛋白、肌酐及射血分数（EF），术中是否应用球囊反搏术、转机时间（CPB）、主动脉阻断时间（ACC）及输血量，术后生命体征、肾功能、24h引流量、APACHEⅡ评分及机械通气时间等围手术期临床指标进行回顾性分析。结果显示，患者年龄、术前白蛋白和EF，CPB、ACC、是否行球囊反搏术，术后APACHEⅡ评分、血糖、肌酐、血小板、APTT、氧合指数、是否再次行开胸探查术等围手术期参数差异有显著性（P〈0．05）；Logistic多元回归分析显示低EF（EF〈40％，OR=6．07）、CPB（〉234min，OR=4．69）及ACC时间（〉172min，OR=4．32）延长、术后高APACHEⅡ评分（〉16，OR=5．36）是体外循环术后延迟撤机患者预后的主要影响因素。提示体外循环术后患者EF低、CPB（〉234min，OR=4．69）及ACC时间延长、术后APACHEⅡ评分高是延迟撤机的主要危险因素。

Analysis of Risk Factors in Postoperative Patients with Prolonged Ventilation after Extracorporeal Circulation

To analyze the risk factors in postoperative patients with prolonged mechanical ventilation after extracorporeal circulation from May 2005 to October 2007, there occurred 305 cases of postoperative patients undergoing extracorporeal circulation in intensive care unit （ICU）. Patients were divided into two groups based on the duration of mechanical ventilation. Patients requiring mechanical ventilation for less than 24 hours were included in early extubation group and those re quiring ventilation for 24 hours or longer than 24 hours were included in prolonged ventilation group. Preoperative variables including blood glucose, serum albumin, Creatinine and ejection fraction （EF）, intraoperative variables such as intra -aortic balloon pump （IABP） usage, cardiopulmonary bypass （CPB） duration, aortic cross clamp （ACC） time, blood transfusion and postoperative variables like vital sign arrival at ICU, renal function, drainage in first 24 hours, acute physiology and chronic health evaluation （APACHE Ⅱ ） score, ventilation duration were analyzed retrospectively. There were significant difference （P〈0.05） in age, blood glucose, serum albumin, EF, IABP, CPB, ACC, APACHE Ⅱ, Creatinine, APTT , PLT and oxygenation index between two groups. Stepwise logistic regression analysis indicated that EF 〈 40G（OR=6.07）, prolongedCPB （〉234min,OR=4.69） and ACC （〉172min,OR=4.32）, high APACHEⅡ scores （〉16,OR= 5.36） were risk factors of prolonged ventilation. Therefore,low EF, prolonged CPB and ACC time, high APACHEⅡ scores are major risk factors in postoperative patients with prolonged ventilation after extracorporeal circulation.