Risk factors and prognosis of prolonged mechanical ventilation after off-pump coronary artery bypass grafting

doi:10.3877/cma.j.issn.1674-6880.2020.03.005

Abstract

Abstract:

Objective

To analyze factors influencing prolonged mechanical ventilation (PMV) after off-pump coronary artery bypass grafting (OPCABG) and its effect on the prognosis of patients.

Methods

A retrospective analysis of 1 097 patients receiving OPCABG were collected at Beijing Anzhen Hospital, Capital Medical University from June 2013 to December 2018. According to their postoperative tracheal intubation time, patients were divided into a control group (postoperative tracheal intubation time ≤ 24 h, n = 972) and a PMV group (postoperative tracheal intubation time > 24 h, n = 125). The clinical data before, during, and after operation were compared in the two groups. Multivariate Logistic regression analysis was used to screen relevant factors for PMV; then the effect of PMV on the prognosis of patients receiving OPCABG was explored.

Results

The New York Heart Association (NYHA) classification ( χ² = 34.138, P < 0.001) and left ventricular diastolic function grade ( χ² = 215.175, P < 0.001) in the control group and PMV group both showed significant differences. Compared with the control group, the age [(62 ± 9) years vs. (67 ± 9) years, t = 6.618, P < 0.001], operation time [(4.0 ± 1.2) h vs. (5.9 ± 2.5) h, t = 8.246, P < 0.001], number of graft vessels [(2.8 ± 0.6) branches vs. (3.2 ± 0.9) branches, t = 4.769, P < 0.001], coronary endarterectomy (CE) [4.0% (39 / 972) vs. 20.8% (26 / 125), χ² = 55.998, P < 0.001], and surgical ventricular restoration (SVR) [2.3% (22 / 972) vs. 12.8% (16 / 125), χ² = 36.771, P < 0.001] in the PMV group were significantly higher, while the left ventricular ejection fraction (LVEF) [(58 ± 6)% vs. (47 ± 7)%, t = 18.006, P < 0.001] was significantly lower. Then the age, NYHA classification, LVEF, left ventricular diastolic function grade, operation time, number of graft vessels, CE, and SVR were included in multivariate regression analysis. The results showed that the age [odds ratio (OR) = 1.881, 95% confidence interval (CI) (1.399, 2.529), P < 0.001], NYHA classification [OR = 1.476, 95%CI (1.220, 1.785), P < 0.001], left ventricular diastolic function grade [OR = 2.866, 95%CI (1.712, 4.799), P < 0.001], operation time [OR = 1.599, 95%CI (1.068, 2.394), P = 0.003], and SVR [OR = 2.334, 95%CI (1.196, 4.554), P < 0.001] were independent risk factors for postoperative PMV in patients receiving OPCABG, whereas LVEF [OR = 0.287, 95%CI (0.189, 0.436), P = 0.009] was a protective factor. The arrhythmia [29.6% (37 / 125) vs. 14.7% (143 / 972), χ² = 17.898, P < 0.001], pulmonary infection [10.4% (13 / 125) vs. 2.3% (22 / 972), χ² = 26.281, P < 0.001], pleural effusion [12.8% (16 / 125) vs. 3.0% (29 / 972), χ² = 27.131, P < 0.001], serum creatinine [(114 ± 37) μmol / L vs. (81 ± 27) μmol / L, t = 9.547, P < 0.001], cerebrovascular events [10.4% (13 / 125) vs. 3.2% (31 / 972), χ² = 14.957, P = 0.001], gastrointestinal events [17.6% (22 / 125) vs. 4.0% (39 / 972), χ² = 38.939, P < 0.001], ICU stay [(43 ± 20) h vs. (13 ± 8) h, t = 16.187, P < 0.001], hospital stay [(11 ± 9) d vs. (6 ± 3) d, t = 5.937, P < 0.001], and 30-d mortality [8.8% (11 / 125) vs. 0.9% (9 / 972), χ² = 38.365, P < 0.001] after operation in the PMV group were significantly higher than those in the control group.

Conclusions

The age, NYHA classification, LVEF, left ventricular diastolic function grade, operation time, and concurrent SVR are related factors for PMV in patients undergoing OPCABG. Prevention of PMV can reduce the occurrence of multiple postoperative complications, shorten the hospital stay, and decrease the 30-d mortality of patients.

Key words: Coronary artery bypass grafting, Prolonged mechanical ventilation, Risk factor, Prognosis

Yuan Zhou, Xiubin Yang. Risk factors and prognosis of prolonged mechanical ventilation after off-pump coronary artery bypass grafting[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 181-187.

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References 24

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组别	例数	年龄（岁）	性别比（例，男/女）	身高（cm）	BMI（kg / m²）	吸烟[例（%）]	高血压[例（%）]	糖尿病[例（%）]	高脂血症[例（%）]	脑血管疾病[例（%）]
对照组	972	62 ± 9	681 / 291	164 ± 10	25.8 ± 2.7	503（51.7）	811（83.4）	498（51.2）	477（49.1）	163（16.8）
PMV组	125	67 ± 9	85 / 40	165 ± 7	26.2 ± 3.1	67（53.6）	106（84.8）	65（52.0）	62（49.6）	23（18.4）
t / χ²值	?	6.618	0.224	1.642	1.368	0.152	0.150	0.026	0.012	0.209
P值	?	< 0.001	0.637	0.102	0.173	0.697	0.698	0.872	0.912	0.648
组别	例数	NYHA分级[例（%）]				LVEF（%）	左室舒张功能分级[例（%）]
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	LVEF（%）	0级	Ⅰ级	Ⅱ级	Ⅲ级
对照组	972	197（20.3）	205（21.1）	385（39.6）	185（19.0）	58 ± 6	65（6.7）	337（34.7）	469（48.3）	101（10.4）
PMV组	125	8（6.4）	17（13.6）	52（41.6）	48（38.4）	47 ± 7	3（2.4）	13（10.4）	32（25.6）	77（61.6）
t / χ²值	?	34.138				18.006	215.175
P值	?	< 0.001				< 0.001	< 0.001
组别	例数	慢性肾病[例（%）]	COPD[例（%）]	PCI [例（%）]	手术时间（h）	移植桥血管数目（支）	CE发生率[例（%）]	SVR发生率[例（%）]	术中出血量（mL）
对照组	972	13（1.3）	157（16.2）	101（10.4）	4.0 ± 1.2	2.8 ± 0.6	39（4.0）	22（2.3）	637 ± 289
PMV组	125	2（1.6）	23（18.4）	15（12.0）	5.9 ± 2.5	3.2 ± 0.9	26（20.8）	16（12.8）	628 ± 291
t / χ²值	?	2（1.6）	0.408	0.303	8.246	4.769	55.998	36.771	0.328
P值	?	0.812	0.523	0.582	< 0.001	< 0.001	< 0.001	< 0.001	0.743

组别	例数	年龄（岁）	性别比（例，男/女）	身高（cm）	BMI（kg / m²）	吸烟[例（%）]	高血压[例（%）]	糖尿病[例（%）]	高脂血症[例（%）]	脑血管疾病[例（%）]
对照组	972	62 ± 9	681 / 291	164 ± 10	25.8 ± 2.7	503（51.7）	811（83.4）	498（51.2）	477（49.1）	163（16.8）
PMV组	125	67 ± 9	85 / 40	165 ± 7	26.2 ± 3.1	67（53.6）	106（84.8）	65（52.0）	62（49.6）	23（18.4）
t / χ²值	?	6.618	0.224	1.642	1.368	0.152	0.150	0.026	0.012	0.209
P值	?	< 0.001	0.637	0.102	0.173	0.697	0.698	0.872	0.912	0.648
组别	例数	NYHA分级[例（%）]				LVEF（%）	左室舒张功能分级[例（%）]
组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	LVEF（%）	0级	Ⅰ级	Ⅱ级	Ⅲ级
对照组	972	197（20.3）	205（21.1）	385（39.6）	185（19.0）	58 ± 6	65（6.7）	337（34.7）	469（48.3）	101（10.4）
PMV组	125	8（6.4）	17（13.6）	52（41.6）	48（38.4）	47 ± 7	3（2.4）	13（10.4）	32（25.6）	77（61.6）
t / χ²值	?	34.138				18.006	215.175
P值	?	< 0.001				< 0.001	< 0.001
组别	例数	慢性肾病[例（%）]	COPD[例（%）]	PCI [例（%）]	手术时间（h）	移植桥血管数目（支）	CE发生率[例（%）]	SVR发生率[例（%）]	术中出血量（mL）
对照组	972	13（1.3）	157（16.2）	101（10.4）	4.0 ± 1.2	2.8 ± 0.6	39（4.0）	22（2.3）	637 ± 289
PMV组	125	2（1.6）	23（18.4）	15（12.0）	5.9 ± 2.5	3.2 ± 0.9	26（20.8）	16（12.8）	628 ± 291
t / χ²值	?	2（1.6）	0.408	0.303	8.246	4.769	55.998	36.771	0.328
P值	?	0.812	0.523	0.582	< 0.001	< 0.001	< 0.001	< 0.001	0.743

危险因素	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄	0.637	0.151	17.796	< 0.001	1.881	1.399 ~ 2.529
NYHA分级	0.386	0.097	15.835	< 0.001	1.476	1.220 ~ 1.785
LVEF	-1.261	0.213	35.049	0.009	0.287	0.189 ~ 0.436
左室舒张功能分级	1.061	0.263	16.275	< 0.001	2.866	1.712 ~ 4.799
手术时间	0.471	0.206	5.228	0.003	1.599	1.068 ~ 2.394
移植桥血管数目	-0.048	0.313	0.024	0.157	0.953	0.516 ~ 1.760
CE	0.110	0.639	0.029	0.120	1.115	0.319 ~ 3.901
SVR	0.853	0.341	6.257	< 0.001	2.334	1.196 ~ 4.554

危险因素	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄	0.637	0.151	17.796	< 0.001	1.881	1.399 ~ 2.529
NYHA分级	0.386	0.097	15.835	< 0.001	1.476	1.220 ~ 1.785
LVEF	-1.261	0.213	35.049	0.009	0.287	0.189 ~ 0.436
左室舒张功能分级	1.061	0.263	16.275	< 0.001	2.866	1.712 ~ 4.799
手术时间	0.471	0.206	5.228	0.003	1.599	1.068 ~ 2.394
移植桥血管数目	-0.048	0.313	0.024	0.157	0.953	0.516 ~ 1.760
CE	0.110	0.639	0.029	0.120	1.115	0.319 ~ 3.901
SVR	0.853	0.341	6.257	< 0.001	2.334	1.196 ~ 4.554

组别	例数	心律失常[例（%）]	心房颤动[例（%）]	肺部感染[例（%）]	胸腔积液[例（%）]	伤口感染[例（%）]	血清肌酐（μmol / L）
对照组	972	143（14.7）	131（13.5）	22（2.3）	29（3.0）	51（5.2）	81 ± 27
PMV组	125	37（29.6）	21（16.8）	13（10.4）	16（12.8）	7（5.6）	114 ± 37
t / χ²值	?	17.898	1.024	26.281	27.131	0.028	9.547
P值	?	< 0.001	0.312	< 0.001	< 0.001	0.868	< 0.001
组别	例数	脑血管事件[例（%）]	胃肠道事件[例（%）]	住ICU时间（h）	术后住院时间（d）	30 d病死率[例（%）]
对照组	972	31（3.2）	39（4.0）	13 ± 8	6 ± 3	9（0.9）
PMV组	125	13（10.4）	22（17.6）	43 ± 20	11 ± 9	11（8.8）
t / χ²值	?	14.957	38.939	16.187	5.937	38.365
P值	?	0.001	< 0.001	< 0.001	< 0.001	< 0.001

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