体外循环心脏直视手术后低氧危险因素分析.docVIP

体外循环心脏直视手术后低氧危险因素分析 　 作者：李欣，王华，郭震，朱金洪 【摘要】 目的 进行体外循环（Extracorporeal circulation，ECC）心脏直视手术患者发生术后低氧的危险因素分析。方法 2004年1月至4月在上海市胸科医院接受ECC心脏直视手术的成人患者中，选取住院号末位数为偶数的患者资料作为统计资料，将术前、术中、术后多种因素与术后1 h、6 h、12 h、24 h患者的氧合指数之间进行相关性研究。结果 ECC心脏直视手术后低氧的相关危险因素有高龄、术前心功能差、肾功能不全、肺动脉压力高、ECC时间和主动脉阻断时间长、术后需要应用米力农和较大量多巴胺维持等；而性别、肥胖度、左室射血分数、ECC灌注流量、血液稀释度、ECC液体出入量与术后低氧并没有确定的相关关系。结论 ECC心脏直视手术患者发生术后低氧的危险因素是多方面的。为了避免出现较严重的术后并发症，预防措施应涵盖术前、术中、术后的各个阶段。 【关键词】 低氧血症；氧合指数；体外循环 　　A Clinical Study on Risk Factors of Post Extracorporeal Circulation Hypoxemia 　　Abstract: OBJECTIVE To evaluate the preoperative, intraoperative and postoperative factors contributing to the development of hypoxemia within the first 24 hours after cardiac surgery. METHODS 175 adult patients who accepted cardiac surgery with extracorporeal circulations (ECC) between Jan and Apr of 2004 were studied. Preoperative clinical and laboratory data were recorded, as were intraoperative and postoperative data regarding the PaO2/FiO2 ratio, fluid and drug therapy. Data analysis evaluated hypoxemia as depicted by the PaO2/FiO2 ratio at 1, 6, 12 and 24 hours after surgery. The risk factors were analyzed in 3 separate periods: preoperative, intraoperative and postoperative. Univariate and multivariate analyses were performed on each period separately. RESULTS Signiftcant risk factors for hypoxemia were age, reduced cardiac function, high creatinine level, pulmonary hypertension, prolonged ECC time, needing of dopamine and milrinone after surgery. CONCLUSION This study shows that the risk factors for hypoxemia were multifarious. The preventive measures should be taken during preoperative, intraoperative and postoperative. 　　Key words：Hypoxemia; Oxygenation index; Extracorporeal circulation 　　术后低氧是体外循环（Extracorporeal circulation，ECC）心脏直视手术的一种较常见的术后并发症，虽然大多数表现为亚临床症状的功能改变，但一旦发生，将明显增加患者的住院时间和医疗费用，因此引起广泛关注。中国分别于1982年、1988年、1997年和1999年四次召开急性呼吸窘迫综合征研讨会，将术后低氧的诊断标准定为氧合指数（PaO2/FiO2）≤300 mm Hg［1］。上海市胸科医院体外循环室据此进行了ECC心脏直视手术患者发生术后低氧的危险因素分析。 　　1 对象与方法 　　1.1