Analysis Of Risk Factors For Postoperative Delayed Removal Of Endotracheal Tubes In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Coronary atherosclerotic heart disease(CHD)is the most common cardiovascular disease severely impairing human’s health and the quality of patients’ life and its pathological changes are lipid components’ deposition,fibrosis,calcification and smooth muscle cell proliferation extending to the medio-coronary artery,which thickens blood vessel wall,forms atheromatous plaque,causes diffuse inadequate myocardial blood supply and leads to the occurrence of angina pectoris.Off-pump coronary artery bypass grafting(OPCABG)is a complete vascular graft on the surface of the beating heart in patients,with surgical trauma,postoperative complications,quick recovery and low incidence of postoperative,especially for elderly,severe disease,intolerant to cardiopulmonary bypass in patients with coronary heart disease.Fast track anesthesia emphasizes the ideal anesthesia technology as the foundation through the standardized treatment process making the function of important organs of patients as soon as possible recover from surgery,patients extubated earlier after surgery,and the ICU and hospital stay shortened as the main purpose.Its advantage has been demonstrated in OPCABG feasible,safe and effective.The establishment of fast track anesthesia technology based on short acting narcotic drugs,early extubation’s goals usually refers to the removal of the endotracheal tube after cardiac surgery in 1~6h.Early extubation can make patients stop positive pressure ventilation,reduce right ventricular afterload,increase left ventricular preload and the circulation function of patients is improved.Earlier extubated not only can reduce the sedative,analgesic and muscle relaxant dosage were less and patients recovered morequickly,coughed more effectively and respiratory mucosa and pulmonary function was improved in earlier extubated patients.Patients foodintake could uptake function of the digestive system and restore nutrients to patient’s after operation,accelerate the recovery of physical function.Catheter in patients undergoing cardiac surgery does not increase the incidence of postoperative complications,but can reduce the perioperative drug application amount and species,shorten the postoperative ICU and hospitalization stay,reduce the consumption of medical resources and medical costs.Although early extubation after cardiac surgery has many advantages,there are still some patients with OPCABG need long-term ventilator support after operation,so it is necessary to further explore the causes of postoperative delayed extubation in patients with OPCABG and investigate the possible preventive measures to improve prognosis in the patients.Objective: To investigate and analyze the risk factors for postoperative delayed removal of endotracheal tubes in patients undergoing OPCABG.Methods: Preoperative,intraoperative and postoperative data of 600 patients undergoing OPCABG alone for the first time from January 2010 to December 2016 were retrospectively analyzed.According to the postoperative extubation time,the 600 patients were divided into 2 groups: early extubation group and delayed extubation group.In group early extubation,287 patients were extubated within and at 6 h after surgery.In delayed extubation group,313 patients were extubated 6 h afterwards.Nineteen parameters as follows were recorded: the parameters of base line patients characteristics including age,gender and body mass index(BMI),preoperative complications including arrhythmia,myocardial infarction,hypertension,diabetes,hyperlipidemia,chronic obstructive pulmonary disease(COPD),cerebrovascular disease,carotid artery stenosis,left main coronary artery disease,left ventricular ejection fraction and left ventricular aneurysm,whether anticoagulant drugs stopped or not,whether the vasoconstrictor drugs(norepinephrine,dopamine,epinephrine and ephedrine)taken or not during the surgery,number of grafts,volume of autologous blood transfusion and operation time.The alternativefactors were identified by univariate model,including measurement data with normal distribution and equal variance.The comparison between the groups was determined using t test or using the rank sum test when didn’t accord with normal distribution,while the enumeration data using the χ2 test.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify postoperative delayed removal of endotracheal tubes in patients undergoing OPCABG.The difference was significant when P values were less than 0.05.Result: A total of 600 patients were enrolled in the study.Of the 600 patients,313 patients suffered from postoperative delayed extubation,and the incidence was 52.2%.The results of Logistic regression analysis showed that female(OR=2.172,95%CI 1.397~3.376),age≥60 yr(OR=1.253,95%CI1.062~1.479),BMI≥24kg/m2(OR=1.354,95%CI 1.064~1.723),autologous blood transfusion volume ≥400ml(OR=1.230,95%CI 1.063~1.422)were the independent risk factors for postoperative delayed removal of endotracheal tubes in patients undergoing OPCABG(P<0.05).Conclusion: Female,Age≥60 yr,BMI≥24kg/m2,autologous blood transfusion volume≥400ml are the independent risk factors for postoperative delayed removal of endotracheal tubes in patients undergoing OPCABG.