经胸壁肺动脉导管持续监测肺动脉压力对心脏手术患者预后的研究

doi:10.3969/j.issn.1009-976X.2020.06.013

摘要/Abstract

摘要： 目的本研究旨在证明通过经胸壁肺动脉导管持续监测肺动脉压力（PAP）的可行性,并研究心脏术后患者PAP变异性与术前危险因素、30天全因死亡率、术后终点事件的相关性。方法将在中山大学孙逸仙纪念医院心胸外科施行开胸心脏及大血管手术并术中放置经胸壁肺动脉导管（TPAC）的526位患者纳入本研究。连续监测术后PAP,计算出肺动脉压力-时间曲线超出压力正常范围的面积,该面积表示了PAP在监测期间总的变异性。单位时间变异性越大（AVPAPs and AVPAPd）,代表术后肺动脉压力变异性越大。通过逻辑回归分析对肺动脉压力变异性与30天全因死亡率进行统计分析。结果计算所得的肺动脉压力变异性（AVPAPs=7.79±7.51 mmHg,AVPAPd=7.75±4.50 mmHg）。对AVPAPs和AVPAPd与30天全因死亡率分别进行逻辑回归分析,发现两者均与30天全因死亡率相关性有统计学意义。AVPAPs OR值为1.050（95%CI：1.025~1.11）,P=0.001;AVPAPd OR值为1.105（95%CI：1.025~1.191）,P=0.009。AVPAPs与30天全因死亡率的相关性可以与纳入回归分析的其他危险因素相拟合,拟合度良好（P=0.748）。结论本研究揭示了心脏外科术后持续监测肺动脉压力超出正常范围的变异性与术后30天全因死亡率有明显相关性,变异性越大,预后越差。术后肺动脉压力变异性与术后肺部感染率、术后房颤发生率同样有相关性。

关键词: 心血管围术期, 肺动脉压

Abstract: Objective Preoperative pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. It is little known whether peri-operative pulmonary artery pressure impacts short-term mortality after cardiac surgery. Methods Totally 526 adult patients without preoperative pulmonary hypertension who underwent different types of cardiac surgery were included in the present study. Pulmonary artery pressure （PAP） was continuously monitored and recorded through a trans-thoracic pulmonary artery catheter （TPAC） being put intra-operatively. The area under PAP pressure-time curve was calculated. The total variation of PAP under the period of monitoring was presented by the area exceeded normal range of PAP. Average variation of systolic and diastolic PAP （AVPAPs and AVPAPd） in each hour under the period of monitoring was calculated. Relationship between AVPAP and 30-day mortality was analyzed by using logistic regression. Results Patients with larger peri-operative AVPAPs had significantly higher 30-day mortality （P< 0.05）. The odds ratio was 1.050 （95% confidence interval, 1.002~1.100） for AVPAPs. AVPAPs showed a significant correlation to postoperative pulmonary infection （P< 0.001） and atrial fibrillation （P< 0.001）. Conclusion Peri-operative variation of systolic PAP showed an adverse impact on short-term mortality and was correlated with postoperative pulmonary infection and atrial fibrillation in patients underwent cardiac surgery.

Key words: cardiovascular surgery, pulmonary arterial pressure

中图分类号:

R654.2

张露, 高敏楠, 江慧琦, 曾宽, 杨艳旗. 经胸壁肺动脉导管持续监测肺动脉压力对心脏手术患者预后的研究[J]. 岭南现代临床外科, 2020, 20(06): 746-752.

ZHANG Lu, GAO Min-nan, JIANG Hui-qi, ZENG Kuan, YANG Yan-qi. Impact of peri-operative variation of pulmonary artery pressure on short-term mortality after cardiac surgery[J]. Lingnan Modern Clinics In Surgery, 2020, 20(06): 746-752.

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