CAJ | 학술논문

目的探讨冠状动脉旁路移植术(CABG)后住重症监护病房(ICU)时间延迟的危险因素,为制定CABG术后住ICU时间延迟的防治策略和措施提供依据.方法采用回顾性调查方法,选择宜昌市第一人民医院重症医学科2008年1月至2012年1月CABG术后全部患者病历资料进行分析.以术后住ICU时间＞3d者作为观察组,以术后住ICU时间＜3d者作为对照组；对两组患者潜在的危险因素进行对比分析,并采用非条件logistic多元回归分析判断影响CABG术后住ICU时间延迟的独立危险因素.结果共收治CABG术后患者68例,其中住ICU时间延迟者24例,发生率35.29％.单因素分析结果显示:术后低心排、心律失常、术后呼吸衰竭、术后急性肾衰竭、急诊手术及左房内径为CABG术后住ICU时间延迟的危险因素.Logistic多因素回归分析显示,仅有术后呼吸衰竭[优势比(OR) =6.865,95％可信区间(95％CI)为1.322～35.559]为CABG术后住ICU时间延迟的独立危险因素(P＜0.05).结论术后呼吸衰竭是CABG术后住ICU时间延迟的独立危险因素.对CABG患者危险因素的监控,可减少CABG术后患者住ICU的时间.
목적 탐토관상동맥방로이식술(CABG)후주중증감호병방(ICU)시간연지적위험인소,위제정CABG술후주ICU시간연지적방치책략화조시제공의거.방법 채용회고성조사방법,선택의창시제일인민의원중증의학과2008년1월지2012년1월CABG술후전부환자병력자료진행분석.이술후주ICU시간＞3d자작위관찰조,이술후주ICU시간＜3d자작위대조조；대량조환자잠재적위험인소진행대비분석,병채용비조건logistic다원회귀분석판단영향CABG술후주ICU시간연지적독립위험인소.결과 공수치CABG술후환자68례,기중주ICU시간연지자24례,발생솔35.29％.단인소분석결과현시:술후저심배、심률실상、술후호흡쇠갈、술후급성신쇠갈、급진수술급좌방내경위CABG술후주ICU시간연지적위험인소.Logistic다인소회귀분석현시,부유술후호흡쇠갈[우세비(OR) =6.865,95％가신구간(95％CI)위1.322～35.559]위CABG술후주ICU시간연지적독립위험인소(P＜0.05).결론 술후호흡쇠갈시CABG술후주ICU시간연지적독립위험인소.대CABG환자위험인소적감공,가감소CABG술후환자주ICU적시간.
Objective To investigate the risk factors of prolonged intensive care unit (ICU) stay following coronary artery bypass grafting (CABG),and to provide a reference for effective control measure.Methods A retrospective study was conducted.All data of patients with post CABG admitted to the Department of Critical Care Medicine of the First People's Hospital in Yichang from January 2008 to January 2012 were retrospectively analyzed.The CABG patients staying in ICU more than 3 days served as observation group,and the patients staying in ICU less than 3 days were the control group.Potential risk factors in both groups were compared,and multivariable non-condition logistic regressions analysis was adopted to determine the independent risk factors which resulted in prolonged stay in ICU after CABG.Results Sixty-eight patients underwent CABG were analyzed retrospectively.Twenty-four cases (35.29％) had prolonged stay in ICU after CABG.Univariate analysis showed that the risk factors of prolonged stay in ICU after CABG were low cardiac output,arrhythmia,postoperative respiratory failure,postoperative acute renal failure,emergency operation,and left atrial inner diameter.The multivariable logistic regression analysis showed that the independent risk factor of prolonged stay in ICU after CABG was the postoperative respiratory failure [odds ratio (OR) =6.856,95％ confidence interval (95％CI) 1.322-35.559,P＜0.05].Conclusions The independent risk factor of prolonged stay in ICU after CABG was postoperative respiratory failure.By monitoring the risk factors,duration of stay in ICU after CABG can be decreased.