Analysis Of Risk Factors For Prolonged Mechanical Ventilation (PMV) After Cardiopulmonary Bypass Totally Thoracoscopic Cardiac Surgery

Objective:To study the risk factors affecting prolonged postoperative mechanical ventilation(PMV)in the perioperative period of cardiopulmonary bypass totally thoracoscopic cardiac surgery,and to provide a basis for guiding the perioperative management of total thoracoscopic cardiac surgery.Methods:The clinical data of patients treated with cardiopulmonary bypass totally thoracoscopic cardiac surgery in the Department of Cardiac Surgery of the First Affiliated Hospital of Xinjiang Medical University between January 2017 and June 2021 were retrospectively analyzed,and cases with time≤24 hours were classified as non-PMV group and cases with time>24 hours were classified as PMV group according to the postoperative mechanical ventilation time.The risk factors influencing the occurrence of PMV were derived from univariate analysis using t-test orX~2 test,and then the factors screened by univariate analysis at P<0.05 were included in a binary logistic regression model for multifactor analysis to derive independent risk factors that might lead to the occurrence of PMV in patients.Results:A total of 268 patients met the inclusion criteria,34 in the PMV group and 234 in the non-PMV group,and the incidence of PMV in the whole group was 12.69%.the results of the univariate analysis of PMV suggested that the preoperative factors were:age,smoking history,COPD,left atrial internal diameter,right atrial internal diameter,plasma creatinine value,arterial blood gas lactate value,hypoproteinemia,and preoperative NYHA cardiac function class,and the preoperative intraoperative factors were:operative time,cardiopulmonary bypass time,ascending aortic block time,and whether blood products were used intraoperatively,and postoperative factors were:maximum plasma creatinine value at 24 hours postoperatively,maximum blood gas lactate value at 24 hours postoperatively,maximum PCO2 value at 24 hours postoperatively,minimum oxygenation index at 24 hours postoperatively,chest drainage at 24 hours postoperatively,LVEF%postoperatively,and 24 hours postoperatively Whether blood products were used or not,all these differences were statistically significant(P<0.05).Complication factors were:postoperative pneumothorax or subcutaneous emphysema,postoperative lung infection,ventilator-associated pneumonia,hypoxemia,and acute kidney injury,and all differences were statistically significant(P<0.05).The results of binary logistic regression analysis suggested that history of smoking(OR=117.498,95%CI 11.241 to1228.132),preoperative right atrial internal diameter(OR=1.265,95%CI 1.057 to 1.514),cardiopulmonary bypass time(OR=1.069,95%CI 1.012 to 1.129)were as independent risk factors for the occurrence of PMV after cardiopulmonary bypass totally thoracoscopic cardiac surgery.Conclusion:The presence of preoperative smoking history,preoperative right atrial internal diameter and cardiopulmonary bypass time were all independent risk factors for PMV after cardiopulmonary bypass totally thoracoscopic cardiac surgery.