小婴儿心内直视术后撤离呼吸机失败相关因素分析

摘要

目的：分析小婴儿心内直视术后撤离呼吸机气管插管拔管失败的相关风险因素。方法回顾性分析2012年1月至2014年1月本院行先天性心脏病（先心病）纠治术后计划性气管插管拔管失败、再插管的271例小于3月龄患儿临床资料。结果271例患儿中，32例（11．81％）术后拔管失败，失败组术后膈肌麻痹、NO 吸入、术后肺炎、肺不张的发生率较对照组升高，差异均有统计学意义（P值均＜0.05），Logistic 回归多因素分析显示术后肺炎、肺不张（Odds Ratio：11．2，95％ CI ＝1．36～98．26）的发生与拔管失败的发生显著相关（P 值均＜0．05）。结论术后肺部感染、肺不张是小婴儿心内直视术后撤离呼吸机失败的主要相关因素，小婴儿先心病纠治术后应注意呼吸道管理，加强胸部理疗，防治肺部感染，以提高拔管成功率，缩短监护室滞留时间。%Objective To evaluate the risk factors of the extubation in neonates and small infants under-going open heart surgery.Methods A retrospective analysis was made on the demographics,preoperative,intr-aoperative,postoperative,and peri-extubation data in patients who under cardiac surgery from January 2012 to January 2014.Extubation failure for our study was defined as reintubation within 48 hours after planned extuba-tion. Results Of 271 eligible infants during the study period,extubation failure occurred in 32 /271 (11.81%).The median age of patients was 2.17 ±0.90 months and median weight was 4.47 ±1.45 kg.The patients with failed extubation had higher frequency of diaphragmatic paralysis,nitric oxide inhalation and post-operative pneumonia and atelectasis than the control,and there was significant difference(P <0.05).Logistic multiple-factor analysis had shown that postoperative pneumonia and atelectasis were related to extubation fail-ure (OR11.2,95% CI 1.36 ~98.26,P <0.05). Conclusions Postoperative pneumonia and atelectasis are major risk factors in failed extubation after open-heart operation in neonates and small infants.To treat postop-erative pneumonia and enhance chest physiotherapy will be beneficial to wean from the ventilation.