CAJ | 학술논문

目的探讨先天性心脏病(CHD)伴重度肺动脉高压(PH)体外循环(CPB)术后的拔管时机.方法对行CPB手术的40例CHD伴重度PH患者的临床资料进行回顾性分析,按术后机械通气时间是否>24h,分为早期拔管组(19例)和延迟拔管组(21例),比较两组影响拔管的围手术期因素.行多因素Logistic回归分析确定延迟拔管(机械通气时间≥72 h)的影响因素.结果两组术前NYHA心功能分级、撤机后肺循环与体循环收缩压比值(Pp/Ps)、CPB时间、CPB温度比较差异有统计学意义(P<0.05或<0.01).术后早期缺氧发作(OR=0.022,95%CI0.001～0.580)和严重低氧血症(OR=0.031,95%CI0.002～0.568)是延迟拔管的独立危险因素.结论 CHD伴重度PH患者若术前NYHA心功能分级≥Ⅲ级、撤机后Pp/Ps>0.5、CPB时间>90 min或CPB温度<32℃,可考虑延迟拔管.对术后早期有缺氧发作或严重低氧血症者,宜延迟拔管并加强心功能和肺动脉压监测;对无上述情况且术后心肺功能稳定者可考虑早期拔管.
목적 탐토선천성심장병(CHD)반중도폐동맥고압(PH)체외순배(CPB)술후적발관시궤.방법 대행CPB수술적40례CHD반중도PH환자적림상자료진행회고성분석,안술후궤계통기시간시부>24h,분위조기발관조(19례)화연지발관조(21례),비교량조영향발관적위수술기인소.행다인소Logistic회귀분석학정연지발관(궤계통기시간≥72 h)적영향인소.결과 량조술전NYHA심공능분급、철궤후폐순배여체순배수축압비치(Pp/Ps)、CPB시간、CPB온도비교차이유통계학의의(P<0.05혹<0.01).술후조기결양발작(OR=0.022,95%CI0.001～0.580)화엄중저양혈증(OR=0.031,95%CI0.002～0.568)시연지발관적독립위험인소.결론 CHD반중도PH환자약술전NYHA심공능분급≥Ⅲ급、철궤후Pp/Ps>0.5、CPB시간>90 min혹CPB온도<32℃,가고필연지발관.대술후조기유결양발작혹엄중저양혈증자,의연지발관병가강심공능화폐동맥압감측;대무상술정황차술후심폐공능은정자가고필조기발관.
Objective To discuss the timing of extubation in patients of congenital heart disease (CHD)with severe pulmonary hypertension (PH) undergoing connective surgery with cardiopulmonary bypass(CPB).Methods A retrospective study of 40 patients of CHD with severe PH Was completed.According to whether the duration of mechanical ventilation (MV)>24 hours,patients were divided into two groups,early extubafion group(19 patients) and late extubation group(21 patients).Perioperative variables that might influence duration of MV were compared between the two groups.Multivariate statistical analysis with Logistic regression was used for these patients to analyze the perioperative variables to determine risk factors for prolonged MV (MV≥72 hours).Results Between the two groups,preoperative NYHA class,Pp/Ps at the time of coming off bypass,CPB duration,and CPB temperature were significantly different (P<0.05 or<0.01).Anofic spell (OR=0.022,95%CI0.001-0.580)and severe hypoxemia(OR=0.031,95%CI0.002-0.568)in the early postoperative period were the risk factors for prolonged MV.Conclusions The timing of extubation in these patients should be determined individually.Late extubation may fit those with advanced NYHA class,high Pp/Ps at the time of coming off bypass,prolonged CPB duration,or hypothermic cardiography and pulmonary artery catheter monitoring help to guide treatment for pwlonged MV.For else patients who with postoperative stable cardiopulmonary function,early extubation maybe feasible.