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肺移植术后机械通气延长的危险因素分析

王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析[J]. 器官移植, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
引用本文: 王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析[J]. 器官移植, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
Wang Dapeng, Li Xiaoshan, Xuan Chenhao, et al. Analysis of risk factors of prolonged mechanical ventilation after lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016
Citation: Wang Dapeng, Li Xiaoshan, Xuan Chenhao, et al. Analysis of risk factors of prolonged mechanical ventilation after lung transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 797-802. doi: 10.3969/j.issn.1674-7445.2022.06.016

肺移植术后机械通气延长的危险因素分析

doi: 10.3969/j.issn.1674-7445.2022.06.016
基金项目: 

江苏省科技计划专项资金 BE2022697

无锡市卫生健康委科研项目 Q202003

详细信息
    作者简介:
    通讯作者:

    许红阳,博士,主任医师,研究方向为肺移植围手术期管理,Email:xhy1912@aliyun.com

  • 中图分类号: R617

Analysis of risk factors of prolonged mechanical ventilation after lung transplantation

More Information
  • 摘要:   目的  探讨肺移植受者术后机械通气延长(PMV)的危险因素。  方法  回顾性分析90例肺移植受者的临床资料。根据术后有创机械通气时间分为PMV组(通气时间 > 48 h,30例)和对照组(通气时间≤48 h,60例)。比较两组受者围手术期相关指标,包括术前指标[血清肌酐、估算肾小球滤过率(eGFR)],术中指标(供肺冷缺血时间、出血量),术后指标[首次红细胞、白细胞、血小板计数、血红蛋白、C-反应蛋白、血清肌酐、总胆红素、丙氨酸转氨酶(ALT)、氧合指数、eGFR、入重症监护室(ICU)平均动脉压]。采用多因素logistic层次回归分析肺移植受者术后PMV的危险因素。  结果  PMV组受者术前血清肌酐为62(53,67)μmol/L,高于对照组受者的57(47,62)μmol/L;PMV组受者术前eGFR为97(93,107)mL/min,低于对照组受者的106(102,116)mL/min;PMV组受者术后首次氧合指数为196(157, 286)mmHg,低于对照组受者的250(199,354)mmHg(均为P < 0.05)。多因素分析显示术后首次总胆红素升高、术后首次氧合指数和术前eGFR降低是肺移植术后PMV的独立危险因素。  结论  术后首次总胆红素升高、术后首次氧合指数和术前eGFR降低是肺移植术后PMV的独立危险因素。

     

  • 表  1  两组受者围手术期相关指标的比较

    Table  1.   Comparison of perioperative indexes of recipients between the two groups[M(P25, P75)]

    指标 对照组(n=60) PMV组(n=30) P
    术前指标
      血清肌酐(μmol/L) 57(47,62) 62(53,67) 0.026
      eGFR(mL/min) 106(102,116) 97(93,107) 0.001
    术中指标
      供肺冷缺血时间(min) 515(420,598) 470(379,562) 0.072
      出血量(mL) 1 000(800,1 500) 1 150(800,1 500) 0.322
    术后指标
      首次红细胞(×1012/L) 4(3,4) 4(3,4) 0.976
      首次白细胞(×109/L) 12(8,16) 11(7,15) 0.344
      首次血小板计数(×109/L) 138(116,174) 130(94,156) 0.153
      首次血红蛋白(g/L) 110(100,122) 109(102,122) 0.834
      首次C-反应蛋白(mg/L) 7(4,15) 6(3,16) 0.722
      首次血清肌酐(μmol/L) 55(47,66) 57(45,65) 0.894
      首次总胆红素(μmol/L) 28(22,36) 40(22,50) 0.055
      首次ALT(U/L) 30(21,34) 24(19,33) 0.200
      首次氧合指数(mmHg) 250(199,354) 196(157,286) 0.008
      首次eGFR(mL/min) 103(97,113) 102(91,115) 0.480
      入ICU平均动脉压(mmHg) 84(73,96) 79(72,86) 0.202
    下载: 导出CSV

    表  2  模型拟合的评价分析

    Table  2.   Evaluation and analysis of model fitting

    模型 离差 AIC BIC 模型对比
    对比模型 χ2 P
    1 109.3 113 118
    2 102.4 108 116 1-2 6.911 0.009
    3 96.8 105 115 2-3 5.6 0.018
    4 96.4 106 119 3-4 0.363 0.547
    5 94.5 107 122 4-5 1.93 0.165
    注:①AIC为赤池信息准则。
    ②BIC为贝叶斯信息准则。
    下载: 导出CSV

    表  3  肺移植术后PMV危险因素的多因素logistic回归分析结果

    Table  3.   Multivariate logistic regression analysis of PMV risk factors after lung transplantation

    预测变量 系数 标准误 Z P 比值比 95% CI
    术后首次总胆红素 0.043 20 0.019 34 2.23 0.026 1.044 1.005~1.084
    术后首次氧合指数 -0.005 87 0.002 80 -2.10 0.036 0.994 0.989~0.999
    术前eGFR -0.046 12 0.020 52 -2.25 0.025 0.955 0.917~0.994
    注:①系数表示“是否通气时间延长= 1”与“是否通气时间延长= 0”相比的对数比。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-07-17
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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