Influencing factors for prolonged mechanical ventilation in infants after cardiac surgery with congenital heart disease
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摘要:
目的 探讨影响婴幼儿先天性心脏病体外循环(CPB)心脏直视手术后机械通气时间延长(PMV)的影响因素。 方法 回顾性分析2018年1月-2019年7月在中国科学技术大学附属第一医院需行CPB心脏直视手术的83例先天性心脏病婴幼儿, 根据术后机械通气时间分为早期撤机组(< 24 h, 60例)和晚期撤机组(>24 h, 23例), 对可能造成PMV的影响因素进行分析比较, 包括月龄、体质量、RACHS-1分级、术前是否合并肺炎、左心室射血分数(LVEF)、术前肺动脉压力、术中CPB时间及主动脉阻断(ACC)时间、术中最低酸碱度pH、术后24 h内最高血管活性药物评分(VIS)情况。 结果 单因素分析显示: 月龄、体质量、术前是否合并肺炎、术前肺动脉压力、术中CPB时间及ACC时间、术后24 h内最高VIS均是婴幼儿先天性心脏病术后PMV的影响因素(均P < 0.05)。多因素logistic回归分析显示: 术中CPB时间(OR=1.128, 95%CI: 1.008~1.262, P=0.035)、术后24 h内最高VIS (OR=1.233, 95%CI: 1.023~1.485, P=0.028)是婴幼儿先天性心脏病术后PMV的独立影响因素。 结论 术中CPB时间长、术后24 h内最高VIS高是婴幼儿先天性心脏病术后PMV的主要影响因素。 Abstract:Objective To investigate the influencing factors of prolonged mechanical ventilation (PMV) in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) open heart surgery. Methods A total of 83 infants with CHD who needed CPB open heart surgery in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to July 2019 were retrospectively analyzed.According to the PMV time, they were divided into early-stage withdrawal group (< 24 h, 60 cases) and delayed-stage withdrawal group (> 24 h, 23 cases).The influencing factors of PMV were analyzed and compared, including month age, body weight, RACHS-1 grade, preoperative pneumonia, left ventricular ejection fraction (LVEF), preoperative pulmonary artery pressure, intraoperative CPB time and aortic cross clamp (ACC) time, intraoperative minimum pH, maximum vasoactive-inotropic score (VIS) in the 24 hours after operation. Results There were sixty cases in early-stage withdrawal group and twenty-three cases in delayed-stage withdrawal group.Univariate analysis showed that month age, body weight, preoperative pneumonia, preoperative pulmonary artery pressure, CPB time, ACC time, maximum VIS in the first 24 hour after operation were the influencing factors of PMV (P < 0.05).Multivariate logistic regression analysis showed that CPB time (OR=1.128, 95%CI: 1.008-1.262, P=0.035) and maximum VIS in the first 24 hours after operation (OR=1.233, 95%CI: 1.023-1.485, P=0.028) were the independent influencing factors. Conclusion Long CPB time and high maximum VIS in the first 24 hours after operation are the main influencing factors for PMV of infants with CHD after operation. -
表 1 婴幼儿先天性心脏病RACHS-1分级情况(例)
Table 1. RACHS-1 classification of congenital heart disease in infants (cases)
组别 例数 1级 2级 3级 4级 5级 早期撤机组 60 5 45 10 0 0 晚期撤机组 23 1 12 6 3 1 合计 6 57 16 3 1 
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表 2 婴幼儿先天性心脏病术后机械通气时间延长影响因素的单因素分析
Table 2. Univariate analysis of influencing factors of prolonged mechanical ventilation after surgery for congenital heart disease in infants
组别 例数 性别
(男/女，例)月龄
[M(P25, P75)，月]体质量
(x±s，kg)RACHS-1分级[例(%)] 术前合并肺炎
[例(%)]LVEF
(x±s，%)轻度组 重度组 早期撤机组 60 32/28 14.00(10.25，24.00) 10.63±3.14 50(83.33) 10(16.67) 1(1.66) 68.83±4.29 晚期撤机组 23 9/14 10.00(7.00，15.00) 7.52±1.88 13(56.52) 10(43.48) 6(26.09) 69.95±6.03 统计量 1.342a 411.500b 4.438c 6.535a 9.872a -0.948c P值 0.247 0.004 < 0.001 0.011 0.002 0.346 组别 例数 术前肺动脉压力
[M(P25, P75)，mmHg]CPB时间
(x±s，min)ACC时间
(x±s，min)术中最低pH
(x±s)术后24 h最高VIS
[M(P25, P75)，mmHg]早期撤机组 60 27.50(23.00，32.00) 66.38±16.18 33.73±17.48 7.33±0.08 7.00(5.00，8.00) 晚期撤机组 23 45.00(23.00，61.00) 106.70±30.67 62.91±24.31 7.33±0.13 22.50(10.00，35.00) 统计量 454.500b -7.782c -6.079c -0.211c 195.000b P值 0.016 < 0.001 < 0.001 0.834 < 0.001 注：1 mmHg=0.133 kPa。a为χ2值，b为Z值，c为t值。
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表 3 婴幼儿先天性心脏病术后机械通气时间延长影响因素的多因素分析
Table 3. Multivariate analysis of influencing factors of prolonged mechanical ventilation after surgery for congenital heart disease in infants
变量 B SE Wald χ2 P值 OR值 95% CI 月龄 0.018 0.132 0.019 0.890 1.018 0.787~1.318 体质量 -0.685 0.551 1.545 0.214 0.504 0.171~1.484 术前肺动脉高压 0.019 0.026 0.506 0.477 1.019 0.968~1.073 术中CPB时间 0.121 0.057 4.440 0.035 1.128 1.008~1.262 术后24 h内最高VIS 0.209 0.095 4.837 0.028 1.233 1.023~1.485 术中ACC时间 0.041 0.044 0.875 0.350 0.960 0.881~1.046 术前合并肺炎 2.604 2.485 1.098 0.295 13.514 0.104~1 761.000 注：因变量赋值为早期撤机组=0，晚期撤机组=1。自变量术前合并肺炎赋值：术前不合并肺炎=0，术前合并肺炎=1；其他自变量为连续变量，均以实际值赋值。
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