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大多数先天性心脏病患儿术后需机械通气。拔管失败将导致生理状态不稳定 ,推迟停止机械通气的时间。目的研究导致小婴儿先天性心脏病术后拔管失败的发生率、病因和危险因素。对象 1998年 1月～ 1999年 7月克利夫兰儿童医院危重症监护病房年满 3岁的先天性心脏病患儿。测量与统计方法 采用回顾分析表法。拔管后 2 4h内复插视为拔管失败。收集研究对象术前、术中和术后的相应指标。对每个研究对象的多个非独立资料采取Logistic回归法评价拔管失败的危险因素 ,P <0 0 5为入选评估模型的标准。优势比 (estimatedoddsratio,EOR)以 95 %可信区间表示 ,最终模型的预见性以患者手术特点曲线下的面积判定。结果 2 12名 3岁幼儿实施了 2 30次先天性心脏病手术。11例幼儿 (5 2 % )于围术期死亡 ,2 0 2例幼儿接受了 2 19次手术。 2 5 9% (5 1/ 197)、5 1 8% (10 2 / 197)和 72 6 % (14 3/ 197)的患儿分别于 12、2 4和 4 8h成功拔管。 2 2例首次拔管失败者 ,平均拔管时间为术后 6 7 8h (2 4～ 335 5h) ,其中 5例第 2次拔管亦失败 ,平均拔管时间 189 5h (115 8～ 6 0 2 5h)。拔管失败的早期原因为心功能障碍 (n =6 )、肺疾病 (n =6 )、气道水肿 (n =3)。拔管失败的危险因素为肺高压 (EOR =38 7,95 %CI2
Most children with congenital heart disease require mechanical ventilation after surgery. Extubation failure will lead to instability in the physiological state, postponed the time to stop mechanical ventilation. Objective To study the incidence, etiology and risk factors of unsuccessful extubation after congenital heart disease in infants. Subjects January 1998 ~ July 1999 Cleveland Children’s Hospital Critical Care Unit 3 years old children with congenital heart disease. Measurement and statistical methods using a retrospective analysis table. Extubation within 24 hours after extubation as extubation failure. The subjects were collected before surgery, intraoperative and postoperative indicators. Logistic regression was used to evaluate the risk factors for unsuccessful extubation on multiple, independent data for each subject, P <0 05 for inclusion in the assessment model. The estimated odds ratio (EOR) is expressed as a 95% confidence interval and the predictive value of the final model is based on the area under the patient’s operating characteristic curve. Results Twenty-two 3-year-olds underwent surgery for 230 congenital heart disease. Eleven infants (52%) died during the perioperative period, and 202 infants received 219 operations. Two hundred and ninety-five children (51 1/197), 51.8% (102/297) and 726% (14 3/197) were successfully extubated at 12, 24, and 48 hours respectively. The mean time of extubation was 6278h (2-4 days to 335-5 hours) after the first extubation. Among them, the second extubation failed in 5 cases and the mean extubation time was 189.5 hours (1158 ~ 60 2 5h). Earlier extubation failed due to cardiac dysfunction (n = 6), lung disease (n = 6), airway edema (n = 3). The risk factor for extubation was pulmonary hypertension (EOR = 38 7,95% CI2