目的探討影響心臟瓣膜手術(shù)后呼吸衰竭發(fā)生的相關(guān)危險(xiǎn)因素。方法回顧性分析 2001年 1月至2010年 11月蘭州軍區(qū)蘭州總醫(yī)院 618例心臟瓣膜疾病患者的臨床資料，其中男 339例，女 279例；年齡 10～74（44.01±13.95）歲；風(fēng)濕性心臟病 387例，非風(fēng)濕性心臟病 231例；根據(jù)術(shù)后是否發(fā)生呼吸衰竭分為呼吸衰竭組（ 74例）和非呼吸衰竭組（ 544例），采用單因素及多因素 logistic回歸方法分析術(shù)后呼吸衰竭發(fā)生的危險(xiǎn)因素。結(jié)果心臟瓣膜術(shù)后早期住院死亡率 6.1 %（38/618），呼吸衰竭發(fā)生率 12.0%（74/618）。呼吸衰竭組住院死亡率為 17.6%
（13/74），非呼吸衰竭組住院死亡率 4.6%（25/544），兩組差異有統(tǒng)計(jì)學(xué)意義（ χ2=18.994，P=0.000）。單因素分析顯示，年齡＞ 65歲（P=0.005）、心功能分級(jí)（ NYHA）Ⅳ級(jí)（ P=0.014）、射血分?jǐn)?shù)（ EF）＜ 50.0%（P=0.003）、體外循環(huán)時(shí)間＞ 3 h（P=0.001）、主動(dòng)脈阻斷時(shí)間＞ 2 h（P=0.008）、復(fù)合手術(shù)（同期 CABG、主動(dòng)脈根部置換或射頻消融迷宮手術(shù) P=0.000）、二次手術(shù)（ P=0.012）、術(shù)后并發(fā)癥（ P=0.000）、輸血量＞ 2 000 ml（P=0.000）是心臟瓣膜手術(shù)后呼吸衰竭發(fā)生的潛在危險(xiǎn)因素；多因素 logistic回歸分析結(jié)果顯示，復(fù)合手術(shù)（ P=0.003）、二次手術(shù)（ P=0.010）、術(shù)后并發(fā)癥（P=0.000）、輸血量＞ 2 000 ml（P=0.012）是心臟瓣膜手術(shù)后呼吸衰竭發(fā)生的獨(dú)立預(yù)測因素。結(jié)論重視心臟瓣膜術(shù)后呼吸衰竭發(fā)生的危險(xiǎn)因素，加強(qiáng)圍手術(shù)期處理，縮短體外循環(huán)時(shí)間，減少并發(fā)癥，以減少呼吸衰竭的發(fā)生，降低病死率。
引用本文： 孟毅,董逸飛,董書強(qiáng)等. 心臟瓣膜手術(shù)后呼吸衰竭相關(guān)危險(xiǎn)因素分析. 中國胸心血管外科臨床雜志, 2012, 19(2): 168-171. doi: 復(fù)制
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| 6. | 許建屏, 史藝, 葛翼鵬, 等.瓣膜手術(shù)后呼吸功能衰竭的危險(xiǎn)因素分析.中華胸心血管外科雜志, 2006, 22（4）：217-219. |
| 7. | Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery .Eur J Cardiothorac Surgery, 2008, 34（5）：953-959. |
| 8. | Kolh P, Kerzmann A, Honore C, et al. Aortic valve surgery in octogenarians： predictive factors for operative and long-term results. Eur J Cardiothorac Surg, 2007, 31 （4）：600-606. |
| 9. | Arozullah AM, Daley J, Henderson WG, et al .Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg, 2000, 232（2）： 242-253. |
| 10. | Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg, 2003, 75（3）：853-857. |
| 11. | Rahmanian PB, Adams DH, Castillo JG, et al. Predicting hospital mortality and analysis of long-term survival after major non-cardiac complications in cardiac surgery patients. Ann Thorac Surg, 2010, 90（4）：1221-1229. |
| 12. | Zingone B, Gatti G, Rauber E, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg, 2009, 87（1）：71-78. |
| 13. | 段亮,肖明第,袁忠祥,等.同期行冠狀動(dòng)脈旁路移植及心瓣膜置換術(shù)80例.中國胸心血管外科臨床雜志, 2007, 14（3）：169-172. |
| 14. | Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery .Circulation, 2007, 116（22）：2544-2552. |
| 15. | Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth, 2008, 11（1）：15-19. |
| 16. | Moskowitz D, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery： Is it safe and effective? Ann Thorac Surg, 2010, 90（2）：451-458. |
- 1. Staton GW, Williams WH, Mahoney EM, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial.Chest, 2005, 127（3）：892-901.
- 2. Clark SC. Lung injury after cardiopulmonary bypass. Perfusion, 2006, 21（4）：225-228.
- 3. Apostolakis E, Filos K, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg, 2010, 25（1）：47-55.
- 4. 周智恩, 孫小圣, 嚴(yán)善秀, 等.嬰幼兒體外循環(huán)手術(shù)后呼吸功能衰竭的危險(xiǎn)因素分析.中國體外循環(huán)雜志，2009, 7（3）：129-134.
- 5. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest, 2008, 133（3）：713-721.
- 6. 許建屏, 史藝, 葛翼鵬, 等.瓣膜手術(shù)后呼吸功能衰竭的危險(xiǎn)因素分析.中華胸心血管外科雜志, 2006, 22（4）：217-219.
- 7. Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery .Eur J Cardiothorac Surgery, 2008, 34（5）：953-959.
- 8. Kolh P, Kerzmann A, Honore C, et al. Aortic valve surgery in octogenarians： predictive factors for operative and long-term results. Eur J Cardiothorac Surg, 2007, 31 （4）：600-606.
- 9. Arozullah AM, Daley J, Henderson WG, et al .Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg, 2000, 232（2）： 242-253.
- 10. Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg, 2003, 75（3）：853-857.
- 11. Rahmanian PB, Adams DH, Castillo JG, et al. Predicting hospital mortality and analysis of long-term survival after major non-cardiac complications in cardiac surgery patients. Ann Thorac Surg, 2010, 90（4）：1221-1229.
- 12. Zingone B, Gatti G, Rauber E, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg, 2009, 87（1）：71-78.
- 13. 段亮,肖明第,袁忠祥,等.同期行冠狀動(dòng)脈旁路移植及心瓣膜置換術(shù)80例.中國胸心血管外科臨床雜志, 2007, 14（3）：169-172.
- 14. Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery .Circulation, 2007, 116（22）：2544-2552.
- 15. Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth, 2008, 11（1）：15-19.
- 16. Moskowitz D, McCullough JN, Shander A, et al. The impact of blood conservation on outcomes in cardiac surgery： Is it safe and effective? Ann Thorac Surg, 2010, 90（2）：451-458.