Analysis Of Risk Factors For Respiratory Insufficiency In Elderly (≥65 Years) After Heart Valve Surgery

Objective:The study explores the perioperative risk factors of respiratory insufficiency in elderly patients(≥ 65 years old)after heart valve replacement,and to provide diagnosis and treatment plans for preventing the occurrence of prolonged ventilator-assisted ventilation(PMV)after heart valve replacement.Methods: With reference to the established inclusion-level exclusion criteria,continuous collection of relevant clinical medical records of patients ≥65 years of age who underwent heart valve replacement surgery in the Department of Cardiac Surgery,First Clinical College of Xinjiang Medical University from January 2018 to December 2020,Patients were divided into PMV(prolonged ventilator assisted time)group and non-PMV(non-ventilated assisted time prolonged)group based on whether the cumulative use of ventilator assistance time exceeded 24 hours after surgery,and compared the two groups of patients:preoperative,Intraoperative and postoperative indicators,statistical analysis and expression,and single factor analysis of whether there are statistical differences between the two groups,will further conduct multi-factor analysis on the factors that may prolong the patient’s ventilator assisted ventilation time.Its related independent risk factors.Results: A total of 148 patients with clinical medical records that met the criteria were included in this study.Among them,47 were males and 101 were females,aged 69.4±4.1years old,and the postoperative ventilator assisted ventilation time was 30.2±35.4 hours.The incidence of PMV was 33.7%.There were 50 cases in the PMV group and 98 cases in the non-PMV group.Univariate results suggest: age,preoperative atrial fibrillation,history of coronary heart disease,preoperative serum creatinine value(whether greater than 125 μmol/L),preoperative plasma albumin value(whether less than 30 g/L),Operation complexity,operation time(CPB time,ACCT),intraoperative blood transfusion,postoperative serum creatinine value(whether greater than 125 μmmol/L),whether acute kidney injury occurred postoperatively,and postoperative hemoglobin concentration(whether less than 90g/L),postoperative plasma albumin value(whether less than 30 g/L),ventilator-associated pneumonia,etc.are possible influencing factors.Further logistic regression analysis was performed.The results showed that: heart valve replacement under cardiopulmonary bypass + coronary Pulse bypass surgery,heart valve replacement under cardiopulmonary bypass + left atrial fold surgery;postoperative albumin is less than30 g/L;postoperative massive blood transfusion is an independent risk factor for respiratory insufficiency.Conclusion This study suggests that independent risk factors for long-term ventilator-assisted ventilation after cardiac surgery include: heart valve replacement with cardiopulmonary bypass + coronary artery bypass surgery;heart valve replacement with cardiopulmonary bypass + left atrial fold surgery;massive blood transfusion after surgery And the complication of hypoalbuminemia occurred in the patient after surgery.