上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1320-.doi: 10.3969/j.issn.1674-8115.2011.09.025

• 论 著 • 上一篇    下一篇

小儿先天性心脏病快通道手术后早拔管的体外循环影响因素分析

黄 悦1, 张马忠1, 宋艳艳2, 白 洁1, 林 琳1   

  1. 上海交通大学 1.医学院附属上海儿童医学中心麻醉科, 上海 200127； 2.基础医学院生物统计学教研室, 上海 200025
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 通讯作者: 白 洁, 电子信箱: macker2000@sohu.com。
  • 作者简介:黄 悦（1971—）, 女, 副主任医师, 博士；电子信箱: hy2111@hotmail.com。
  • 基金资助:

    上海市卫生局基金（2007055）

Cardiopulmonary bypass related factors associated with early extubation after surgery for congenital heart disease under fast-track cardiac anesthesia in children

HUANG Yue1, ZHANG Ma-zhong1, SONG Yan-yan2, BAI Jie1, LIN Lin1   

  1. 1.Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China；2.Department of Biostatistics, Basic Medical College, Shanghai Jiaotong University, Shanghai 200025, China
  • Online:2011-09-28 Published:2011-09-27
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2007055

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摘要：

目的 通过对快通道心脏麻醉(FTCA)管理策略下的体外循环(CPB)手术患儿围术期资料的统计分析，建立小儿FTCA术后早拔管时间的界值，进一步分析影响小儿FTCA策略的CPB因素。方法 回顾性分析2 859例先天性心脏病术中接受FTCA管理的病例，对术后呼吸机支持时间经对数转换后进行聚类分析以建立小儿FTCA策略的术后早拔管时间界值，FTCA的影响因素分析采用χ2检验和多因素逐步Cox回归分析。结果 术后呼吸机支持时间的聚类分析显示：术后12 h为早拔管与非早拔管组的分界值，54.56%的患儿拔管时间＜12 h，为早拔管组；45.44%的患儿拔管时间≥12 h，为非早拔管组。据此标准，患儿术后早拔管率：不同CPB时间（≤30、31~60、61~90、91~120、>120 min）组分别为83.1%、66.3%、42.5%、28.7%和26.8%，组间差异有统计学意义(P<0.01)；不同主动脉阻断时间（0、1~30、31~60、61~90、>90 min）组分别为55.6%、71.8%、46.4%、27.6%和20.9%，组间差异有统计学意义(P<0.01)；不同CPB温度（常温、浅低温、中低温、深低温）组分别为66.9%、49.6%、29.0%和21.5%，组间差异有统计学意义(P<0.01)。上述因素的逐步Cox回归分析结果显示：CPB时间越长，术后早拔管率越小；主动脉阻断时间1~30 min组术后早拔管率大于参照组(0 min)(P<0.05)，31~60 min组和61~90 min组与参照组术后早拔管率差异无统计学意义(P>0.05)，主动脉阻断时间>90 min术后早拔管率低于与参照组；CPB期间温度越低，术后早拔管率越小。结论 建立了小儿术后12 h拔管为FTCA策略的术后早拔管时间界值。CPB时间、主动脉阻断时间及温度是影响患儿术后拔管的CPB因素。

关键词: 快通道, 体外循环, 先天性心脏病;手术, 影响因素, 小儿

Abstract:

Objective To analyse the perioperative data of patients undergoing surgery with cardiopulmonary bypass (CPB) under fast-track cardiac anesthesia (FTCA), establish the cutoff value of early extubation in FTCA standards, and explore the CPB related factors associated with FTCA. Methods The data of 2 859 children undergoing surgery for congenital heart disease managed with FTCA strategy were retrospectively analysed. Cluster analysis was performed with logarithmic transformation of the time of mechanical ventilation after surgery to establish pediatric FTCA standards of cutoff value of early extubation after operation. The related factors of FTCA were analysed by chi-square test and stepwise multiple Cox regression analysis. Results Cluster analysis of time of mechanical ventilation after operation revealed that 12 h after operation was the cutoff value for early extubation after operation. There were 54.56% of patients with time of extubation ＜12 h after operation (early extubation group), and there were 45.44% of patients with time of extubation ≥12 h after operation (non-early extubation group). The early extubation rates after operation were 83.1%, 66.3%, 42.5%, 28.7% and 26.8% in different time of CPB (≤30 min, 31-60 min, 61-90 min, 91-120 min and >120 min） groups respectively, and there were significant differences among groups (P<0.01). The early extubation rates after operation were 55.6%, 71.8%, 46.4%, 27.6% and 20.9% in different time of aortic cross-clamping （0 min, 1-30 min, 31-60 min, 61-90 min and >90 min）groups, and there were significant differences among groups (P<0.01). The early extubation rates after operation were 66.9%, 49.6%, 29.0% and 21.5% in different temperatures of CPB (room temperature, mild hypothermia, moderate hypothermia and profound hypothermia) groups, and there were significant differences among groups (P<0.01). Stepwise multiple Cox regression analysis indicated that longer time of CPB resulted in lower rate of early extubation after operation. The rate of early extubation after operation in time of aortic cross-clamping of 1-30 min group was higher than that in control group (0 min)(P<0.05), there was no significant difference in the rates of early extubation after operation between time of aortic cross-clamping of 31-60 min and 61-90 min groups and control group (P>0.05), and the rates of early extubation after operation in time of aortic cross-clamping >90 min group was lower than that in control group. Lower temperature of CPB resulted in lower rate of early extubation after operation. Conclusion Twelve hours after operation was defined as the cutoff value of early extubation in FTCA standard. Time of CPB, time of aortic crossclamping and temperature of CPB are CPB related factors for extubation after operation.

Key words: fast-track, cardiopulmonary bypass, congenital heart disease, surgery, related factors, children