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主动脉夹层术后机械通气延迟脱机的影响因素分析
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Abstract:
目的：探讨主动脉夹层术后机械通气延迟脱机的影响因素。方法：回顾性分析新疆医科大学第一附属医院重症医学科2017年9月至2019年9月期间连续收住的123例主动脉夹层(AD)术后患者的临床资料，其中男104例，女19例，平均年龄46.79 ± 9.16岁，其中DeBakey I型94例，DeBakey II型29例。根据患者术后脱机时间分为两组，机械通气早期脱机组(<48 h)与延迟脱机组(≥48 h)。对两组患者围术期临床指标进行分析，通过Logistic多因素分析确定主动脉夹层术后延迟脱机的独立影响因素，进一步绘制受试者工作特征曲线(receiver operating characteristic curve, ROC)，探讨相关指标对主动脉夹层术后机械通气延迟脱机的预测价值。结果：123例主动脉夹层术后患者机械通气中位时间为96.0 (66.0, 193.0) h，早期脱机组与延迟脱机组患者机械通气中位时间分别为36.0 (14.5, 41.0) h和132.0 (89.0, 231.0) h，延迟脱机率为86.18% (106/123)。两组患者术后死亡率差异无统计学意义(5.88% VS 7.55%, P > 0.05)。多因素Logistic回归分析显示，吸烟(OR = 8.023, 95%CI: 1.745~36.883, P = 0.007)、术前白细胞计数(OR = 1.308, 95%CI: 1.024~1.672, P = 0.032)及术后白蛋白水平(OR = 0.791, 95%CI: 0.639~0.978, P = 0.030)是主动脉夹层术后机械通气延迟脱机的独立影响因素。术前白细胞计数预测术后延迟脱机ROC曲线下面积(AUC)为0.712 (95%CI: 0.599~0.825, P = 0.005)，最佳截断值为：11.03 × 109/L，敏感度59.4%，特异度76.5%；术后血清白蛋白水平预测术后延迟脱机ROC曲线下面积(AUC)为0.785 (95%CI: 0.683~0.886, P < 0.001)，最佳截断值为36.23 g/L，敏感度74.5%，特异度70.6%。术前白细胞计数与术后血清白蛋白水平联合预测ROC曲线下面积(AUC)为0.842 (95%CI: 0.757~0.928, P < 0.001)，敏感度68.9%，特异度94.1%。结论：吸烟、术前白细胞计数和术后血清白蛋白水平是主动脉夹层术后机械通气延迟脱机的独立影响因素。术前白细胞计数与术后血清白蛋白水平对主动脉夹层术后机械通气延迟脱机具有一定的预测价值。
Objective: To investigate the influencing factors of delayed weaning from mechanical ventilation after aortic dissection surgery. Methods: A total of 123 patients after aortic dissection surgery who were consecutively admitted to the Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from September 2017 to September 2019 were retrospectively analyzed. Of all patients included, 104 were male, 19 were female, and the average age was 46.79 ± 9.16 years old; 94 were DeBakey Type I Aortic Dissection, and 29 were DeBakey Type II Aortic Dissection. According to the duration of mechanical ventilation, the patients were divided into early weaning group (<48 h) and delayed weaning group (≥48 h). The preoperative clinical data of the patients were analyzed. In order to explore the value of related data in the predication of delayed weaning from mechanical ventilation after aortic dissection surgery, Logistic regression was used to analyze the independent influencing factors of delayed weaning, and the receiver operating characteristic curve (ROC) was drawn further. Results: The median time of mechanical ventilation in 123 patients with aortic dissection after surgery was 96.0 (66.0, 193.0) h. The median mechanical ventilation time for early and delayed weaning patients was 36.0 (14.5, 41.0) h and 132.0 (89.0, 231.0) h, respectively. The rate of delayed weaning was 86.17% (106/123). There was no statistically
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