肺移植术后机械通气延长的危险因素分析

Analysis of risk factors of prolonged mechanical ventilation after lung transplantation

    摘要
  • 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。

     

    Abstract:
      Objective  To identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation.
      Methods  Clinical data of 90 recipients undergoing lung transplantation were retrospectively analyzed. According to the duration of invasive mechanical ventilation after operation, all recipients were divided into the PMV group (ventilation duration > 48 h, n=30) and control group (ventilation duration≤48 h, n=60). Perioperative parameters were compared between two groups, including preoperative parameters serum creatinine, estimated glomerular filtration rate (eGFR), intraoperative parameters (cold ischemia time of donor lung, blood loss), and postoperative parameters the first red blood cell, white blood cell, platelet count, hemoglobin, C-reactive protein, serum creatinine, total bilirubin, alanine aminotransferase (ALT), oxygenation index, eGFR and the mean arterial pressure in intensive care unit (ICU). The risk factors of PMV after lung transplantation were assessed by multivariate logistic regression analysis.
      Results  Preoperative serum creatinine level in the PMV group was 62 (53, 67) μmol/L, significantly higher than 57 (47, 62) μmol/L in the control group. Preoperative eGFR in the PMV group was 97 (93, 107) mL/min, significantly lower than 106 (102, 116) mL/min in the control group. The first postoperative oxygenation index in the PMV group was 196 (157, 286) mmHg, significantly lower than 250 (199, 354) mmHg in the control group (all P < 0.05). Multivariate analysis showed that the first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease were the independent risk factors for PMV following lung transplantation.
      Conclusions  The first increase of postoperative total bilirubin, the first decrease of postoperative oxygenation index and preoperative eGFR decrease are the independent risk factors for PMV after lung transplantation.

     

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