小儿先心病术后机械通气时间延长的多因素分析及治疗策略

摘要

Objetive To explore the influencing factors of prolonged mechanical ventilation after con-genital heart disease operations in children,optimize extubation time and improve quality of care. Methods From May 201 3 to May 201 6,the clinical data were retrospectively analyzed for 1 88 children undergoing con-genital heart disease operations at our hospital.Eight potential factors of affecting mechanical ventilation time were included for multivariate stepwise Logistic regression analysis.These factors were age,body mass,extracor-poreal circulation time,aorta blocking time,pulmonary hypertension,postoperative low cardiac output,postopera-tive acute lung injury and ventilator-associated pneumonia.Results Extracorporeal circulation time,pulmonary hypertension,postoperative low cardiac output syndrome,postoperative acute lung injury and ventilator-associat-ed pneumonia were closely correlated with prolonged mechanical ventilation of congenital heart disease. Con-clusions Extracorporeal circulation time,pulmonary hypertension,postoperative low cardiac output syndrome, postoperative acute lung injury and ventilator-associated pneumonia are the major influencing factors of pro-longed mechanical ventilation.Thus shortening extracorporeal circulation time,active control of pulmonary hypertension,prevention and control of low cardiac output syndrome and preventions of acute lung injury and ventilator-associated pneumonia is conducive for shortening the time of mechanical ventilation and improving the quality of care.%目的：回顾性分析小儿先心病术后机械通气时间延长的相关因素，探讨相关治疗策略，从而优化拔管时机，提高先心病术后监护质量。方法2013年5月至2016年5月我们收治188例先心病术后患儿，将可能影响机械通气时间的8项因素（年龄、体质量、体外循环时间、主动脉阻断时间、肺动脉高压、术后低心排、术后急性肺损伤、呼吸机相关性肺炎）进行多元逐步 Logistic 回归分析。并归纳机械通气时间延长相关因素的防治策略。结果体外循环时间、肺动脉高压、术后低心排综合征、急性肺损伤、呼吸机相关性肺炎5项因素与先心病术后机械通气时间延长有显著相关性。结论体外循环时间长、肺动脉高压、术后低心排综合征、急性肺损伤、呼吸机相关性肺炎是先心术后机械通气时间延长的主要影响因素。尽量缩短体外循环时间、积极控制肺动脉高压、防治低心排综合征、预防急性肺损伤和呼吸机相关性肺炎，可有效缩短机械通气时间，改善监护质量。