Objective To investigate the high risk factor, and methods for prevention and treatment of prolonged mechanical ventilation( PMV) after cardiopulmonary bypass( CPB) . Methods Between January 2012 and June 2013,512 patients who underwent open heart surgery were divided into two groups based on themechanical ventilation longer than 48 hours or not ( prolonged mechanical ventilation was defined as 48 hours or more).Group Ⅰ:75 patients required prolonged mechanical ventilation. Group Ⅱ:437 patients did not require prolonged mechanical ventilation. Univariate and multivariate logistic regression analysis were used to identify the risk factors. Results The mortality rate of group Ⅰwas 10.7%(8/75).The main causes of complication were respiratory failure (45 ca⁃ses), low cardiac output syndrome (12 cases), stroke (2 cases) and multiple organ failure (5 cases). Multivariate logistic regression analysis identified emergency operation (OR 16.468), CPB time>150 min (OR 4.398), secondary CPB support (OR 18.653), PaO2/FiO2<300 mm Hg ( OR 4.606) , the volume of post-operative drainage per kg>18 ml ( OR 5.666) as the risk factors. Conclu⁃sion The patients with the risk factors need more preoperative care and post-operative care to avoid prolonged mechanical ventilation after CPB.%目的：总结婴幼儿心脏手术后呼吸机辅助时间延长病例的临床特点，探讨发生呼吸机辅助时间延长患者的危险因素和防治措施。方法将2012年1月至2013年6月在本院ICU收治的512例先天性心脏病行心内直视手术婴幼儿患者纳入研究中，其中男250例，女262例；年龄1～36个月。全部患者均在体外循环下行心内畸形根治术。根据术后呼吸机辅助时间是否延长，将512例患者分为两组，组Ⅰ：75例，术后呼吸机辅助时间延长（≥48 h）；组Ⅱ：437例，术后呼吸机辅助时间不延长（＜48 h）。先对各变量进行单因素分析，然后将分析有意义的变量纳入Logistic回归进行多因素分析。结果组Ⅰ死亡8例，病死率为10．7％；发生呼吸功能衰竭45例，低心排血量12例，脑卒中2例，多器官功能衰竭5例。 logistic多因素分析结果显示：急诊手术（0R＝16．468），体外循环时间＞150 min（OR＝4．398），二次体外循环（OR＝18．653），术后入ICU时PaO2／FiO2＜300 mm Hg（ OR＝4．606），术后48 h每公斤体重胸腔引流液总量＞18 ml（ OR＝5．666）为婴幼儿心内直视手术后呼吸机辅助时间延长的独立危险因素。结论临床上可根据体外循环时间、术中是否二次体外循环支持、术后PaO2／FiO2、术后48 h每公斤胸腔引流液总量预测术后呼吸机辅助时间是否延长。
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