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目的 探讨婴儿心内直视术后气管插管拔管失败的危险因素。方法 将 2 0 0 1年 1月至 2 0 0 2年 12月期间在我院行先天性心脏病畸形矫正术后拔管失败、再插管的所有年龄小于 1岁的病例纳入本研究中 ,随机抽取同期拔管成功的所有年龄小于 1岁的病例作为对照组 ,采用Logistic回归模型分析婴儿先心病术后拔管失败的危险因素和独立危险因素 ,用相对危险度OR估计拔管失败与上述因素之间的联系强度。结果 2 2 7例行心内直视术的婴儿有 30例 (13.2 2 % )发生术后拔管失败 ,Logistic回归单因素分析示导致拔管失败、再插管的危险因素有术后机械通气时间 [接触机会比(EOR) =12 .0 ;95 %CI=4 .0 4～ 35 .71;P =0 .0 0 0 9]、术后并发肺炎 (EOR =5 .33;95 %CI =1.81～ 15 .6 8;P =0 .0 0 2 )和术前肺动脉高压 (EOR =2 .80 ;95 %CI =1.2 1～ 10 .4 5 ;P =0 .0 4 1) ,Logistic回归多因素分析示术后肺炎及术前肺动脉高压是拔管失败的独立危险因素 (P <0 .0 5 )。结论 术后肺炎及术前肺动脉高压是婴儿心内直视术后气管插管拔管失败发生的主要相关因素 ,防治肺动脉高压危象、肺炎的发生是提高婴儿心内直视术后气管插管拔管成功率、减少术后死亡率的关键。
Objective To investigate the risk factors of unsuccessful tracheal extubation after open heart surgery in infants. Methods The patients who underwent extubation in our hospital after congenital heart disease correction failed between January 2001 and December 2002 were enrolled in this study. All patients less than 1 year old who underwent reintubation were included in the study randomly. All the patients less than 1 year old who were successful in extubation during the same period were selected as the control group. Logistic regression model was used to analyze the risk factors and independent risk factors of extubation failure in infants with congenital heart disease. The relationship between extubation failure and OR The strength of the connection between. Results Of the 277 infants undergoing open heart surgery, 30 (13.2%) had unsuccessful extubation. Univariate analysis of logistic regression showed that extubation failed. The risk factors for reintubation were postoperative mechanical ventilation Time [opportunity to access (EOR) = 12.0; 95% CI = 4.04 to 35.71; P = .0909] with postoperative pneumonia (EOR = 5.33; 95% CI = 1.81 ~ 15.68; P = 0.002) and preoperative pulmonary hypertension (EOR = 2.80; 95% CI = 1.2 1 ~ 10.45; P = 0.041), Logistic Regression multivariate analysis showed that postoperative pneumonia and preoperative pulmonary hypertension were independent risk factors for extubation failure (P <0.05). Conclusions Postoperative pneumonia and preoperative pulmonary hypertension are the main factors that lead to the failure of extubation of tracheal intubation after open heart surgery in infants. Prevention and treatment of pulmonary hypertension risk, pneumonia is to improve the endotracheal intubation The success rate of extubation, the key to reduce postoperative mortality.