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目的探讨瓣膜手术后发生呼吸功能衰竭的危险因素。方法将2005年1月1日至5月31日间完成的507例瓣膜手术病人,按术后有无呼吸功能衰竭分为两组,进行单因素分析和多因素Lo-gistic回归分析。呼吸衰竭定义为术后机械通气48h以上或全麻拔管6h后再次插管行机械通气。结果发生术后呼吸功能衰竭31例(6·1%)。单因素分析发现术前年龄、心脏手术史、心功能分级、合并冠状动脉粥样硬化性心脏病、心胸比率、呼吸功能、血浆白蛋白浓度,术中合并冠状动脉旁路移植术、体外循环时间、主动脉阻断时间、二次体外循环支持,术后氧合指数与术后发生呼吸功能衰竭有关。经多因素Logistic回归分析发现,年龄≥65岁、术前最大通气量显著减退、术中二次体外循环支持、术后ICU第2h血气氧合指数低于300mmHg,为瓣膜手术后发生呼吸功能衰竭的危险因素。结论临床上可根据年龄、最大通气量、术中是否二次体外循环支持、术后氧合指数预测术后呼吸功能衰竭,并可预先采取措施预防,以减少呼吸功能衰竭的发生。
Objective To investigate the risk factors of respiratory failure after valvular surgery. Methods A total of 507 patients undergoing valve surgery between January 1 and May 31, 2005 were divided into two groups according to their postoperative respiratory failure. Univariate and multivariate logistic regression analysis were performed. Respiratory failure was defined as mechanical ventilation after mechanical ventilation more than 48h or 6h after general anesthesia extubation. Results Postoperative respiratory failure occurred in 31 cases (6.1%). Univariate analysis showed that preoperative age, history of cardiac surgery, heart function grading, coronary heart disease, cardiothoracic ratio, respiratory function, plasma albumin concentration, intraoperative coronary artery bypass grafting, cardiopulmonary bypass time , Aortic occlusion time, second cardiopulmonary bypass support, postoperative oxygenation index and postoperative respiratory failure related. Multivariate logistic regression analysis found that patients aged ≥65 years had a significant decrease in preoperative maximal ventilation and postoperative second cardiopulmonary bypass, with a blood gas oxygenation index of less than 300 mm Hg at 2 hours after ICU, resulting in respiratory failure after valvular surgery Risk factors. Conclusion According to the age, maximum ventilation, intraoperative second cardiopulmonary bypass support, postoperative oxygenation index predict postoperative respiratory failure, and can take precautionary measures in order to reduce the occurrence of respiratory failure.