Multifactorial Analysis Of Prolonged Mechanical Ventilation After Heart Valve Disease Surgery

Objective: to explore the risk factors of delayed extubation in patients with valvular heart disease after cardiopulmonary bypass.Methods: 156 patients with cardiac valve replacement or reconstruction under cardiopulmonary bypass were selected.The patients with delayed tracheal intubation(≥24 hours)were set as delayed extubation group(49 cases),and the rest as normal extubation group(107cases).Preoperative data of the two groups were collected: age,gender,body mass index(BMI),blood group,smoking,NYHA heart function classification,basic disease,nutritional risk screening score,blood gas analysis,blood routine,liver and kidney function,pleural effusion,pericardial effusion,echocardiography,pulmonary hypertension,coronary angiography;intraoperative data: type of operation,operation time,cardiopulmonary bypass time,aorta Blocking time,intraoperative urine volume;data within 24 hours after operation: plasma input volume,urine volume,drainage volume,low cardiac output syndrome,vasoactive drugs,blood routine after operation,liver and kidney function after operation,two items of myocardial infarction after operation,length of stay in the monitoring room,postoperative hospitalization days.The univariate analysis used chi square test,t-test or Mann Whitney U test.The univariate and unconditional binary logistic stepwise regression analysis was used to analyze the suspicious factors.Results: univariate analysis showed that the age,NYHA heart function grade,hypertension,charson’s index of complications,Apache score,nutritional risk screening score,aortic diameter,intraoperative urine volume,postoperative platelet,postoperative bilirubin,postoperative glutamic oxaloaminase,postoperative creatinine,postoperative glomerular filtration rate,postoperative CKMB,postoperative HBDH,length of care room,length of hospitalization were compared between the two groups The difference was statistically significant(P<0.05),but there was no significant difference between the two groups in age,gender,blood type,smoking,blood gas analysis,pleural effusion,pericardial effusion,pulmonary hypertension,coronary angiography,type of operation,operation time,cardiopulmonary bypass time,aortic occlusion time,plasma input in the monitoring room,urine output in the monitoring room and induced flow(P>0.05),The results showed that high NYHA heart function grade(OR= 1.993,P=0.039),low aortic diameter(OR=0.763,P=0.001),increased creatinine(OR=1.026,P<0.001),which were the independent risk factors of delayed extubation(P<0.05).The length of ICU stay in PMV group was longer than that in normal extubation group,68h(47.00,88.75)vs 118h(91.50,161.00)P<0.05;the postoperative hospitalization time was longer than that of the normal extubation group 11d(8,13)vs 13.50d(11.0,17.0)P<0.05.Conclusions: delayed extubation can increase the length of stay in the ICU and the length of stay in the hospital after cardiopulmonary bypass.High preoperative NYHA heart function grade,decreased aortic diameter and increased postoperative creatinine are independent risk factors for delayed extubation.These findings are helpful for doctors to select patients reasonably,and provide more attention for patients with higher postoperative risk,so as to achieve a better clinical effect.