关键词: 全弓置换术, 气管重插管, 危险因素

Abstract:

Objective To analyze the risk factors of tracheal reintubation after total aortic arch replacement and to provide evidence for the prevention of tracheal reintubation after total aortic arch replacement. Methods From January 1， 2019 to June 31， 2020， 162 patients who underwent total aortic arch replacement in the Department of Cardiac Surgery of a tertiary grade-A hospital in Guangdong Province were randomly selected and divided into reintubation group （n = 27） and control group （n = 135） based on the occurrence of tracheal reintubation. The risk factors were analyzed by univariate and multivariate logistic regression. Results Among the 162 patients， 27 cases （16.7%） had tracheal reintubation. Compared with those in the control group， the length of ICU stay and hospitalization cost in the reintubation group were significantly increased （P < 0.001）. Univariate analysis indicated that there were significant differences in terms of age， glomerular filtration rate， diabetes mellitus， ventilator time， pulmonary infection， liver insufficiency， hypoxemia， delirium and cerebrovascular accident （P < 0.05）. Multivariate analysis showed age （OR = 1.069，P = 0.038）， pulmonary infection（OR = 5.227， P = 0.047）， delirium （OR = 7.079， P = 0.011）， and ventilator use time （OR = 1.006，P = 0.001） were independent risk factors for tracheal reintubation after total arch replacement. A regression equation was established as follows： ［Logit （P）=-8.885 + 0.066 × age + 1.654 × pulmonary infection + 1.957 × delirium + 0.006 × time］ of first ventilator use. The area under the ROC curve of the subjects in this model was 0.931（95%CI： 0.884 ~ 0.979）， P < 0.001； The results of Hosmer-Lemeshow test （χ² = 4.76 and P = 0.782） indicated that the model had high accuracy. Conclusion Age， pulmonary infection， delirium and ventilator use time are independent risk factors for tracheal reintubation after total aortic arch replacement.

Key words: total aortic arch replacement, reintubation, risk factors