Paper - WANFANG MED ONLINE

You Position: Home > Paper

Influential factors of fast-track anesthesia for mitral valvuloplasty under complete thoracoscopy

( views:0, downloads:0 )

Author:: No author available

Journal Title:: Chinese Journal of Biomedical Engineering

Issue:: 1

DOI:: 10.3760/cma.j.issn.1674-1927.2020.01.009

Key Word:: 胸腔镜;二尖瓣成形术;危险因素;延迟拔管;thoracoscope;mitral valvuloplasty;risk factors;delayed extubation

Abstract： Objective:To investigate the influencing factors for 6h extubation after mitral valvulooplasty under complete thoracoscopy.Methods:The clinical data of 107 patients undergoing thoracoscopic mitral valvuloplasty (MVP) in our hospital were retrospectively analyzed. The subjects were divided into two groups according to time of extubation: those with extubation at 6 h after operation as the normal group ( n=70) , and those beyond 6 h as the delay group ( n=37) . The clinical data of patients before, during and after surgery were compared between groups. Binary logistic regression analysis was used to identify the potential influencing factors of fast-track anesthesia. Results:There were significant differences between groups in coronary bypass (CPB) time, aortic cross clamp (ACC) time, preoperative pulmonary arterial pressure >60 mmHg, persistent atrial fibrillation, cormobidity with coronary heart disease, intraoperatively pumped dexmedetomidine (DEX) , and serum procalcitonin (PCT) level on the first postoperative day ( P<0.05) . Logistic regression showed that the risk factors for delayed extubation included preoperative cormobidity with coronary heart disease [ OR=4.020, 95% CI (1.341, 16.607) , P=0.023], prolonged CPB time [ OR=0.950, 95% CI (0.911, 0.990) , P=0.015], and postoperative PCT elevation [ OR=0.799, 95% CI (0.701, 0.912) , P=0.001]. The protective factor against delayed extubation wasintraoperative pumped DEX [ OR=0.309, 95% CI (0.090, 1.063) , P=0.042]. Conclusion:Cormobidity with coronary heart disease, prolonged CPB time, and elevated PCT after surgery are risk factors that influence 6 h extubation after thoracoscopic MVP. Intraoperative DEX pumping is a protective factor against delayed extubation.

Reference

[1]陈亚武,李华,石广永,等.全胸腔镜与正中开胸二尖瓣成形手术治疗二尖瓣关闭不全病变的病例对照研究[J].2019,(2).
[2]简杰,卢聪,郭惠明,等.二尖瓣脱垂患者微创胸腔镜二尖瓣成形术332例[J].2017,(3).
[3]雷迁,曾庆诗,钟执文,等.超快通道麻醉在胸腔镜体外循环心脏手术中的应用[J].2016,(2).
[4]李颖,刘彬,黄园琴.体外循环心脏术后高淀粉酶血症对预后的影响[J].2017,(1).
[5]王郝,崔娜,牛芳,等.降钙素原对心脏外科术后重症患者感染的早期预测价值[J].2017,(10).
[6]张建卿,王国锋,陈现杰,等.快通道胸腔镜简单心脏手术的临床观察[J].2014,(12).
[7]曾庆诗,田京灵.胸腔镜心脏手术临床麻醉的经验与展望[J].2017,(5).
[8]王先学,潘道波,邓恢伟,等.右美托咪定对体外循环心脏手术病人心肌缺血再灌注损伤的影响：meta分析[J].2016,(2).
[9]刘健,郭惠明,高强,等.三维胸腔镜下二尖瓣成形术60例临床分析[J].2016,(8).
[10]任悦义,王葵亮,张旭,等.超快通道麻醉在小儿心脏体外循环直视手术中的应用[J].2015,(z1).
[11]卞清明,许仄平,王丽君,等.右美托咪定联合肺保护性通气对胸科手术病人的肺保护作用[J].2017,(9).
[12]刘勇,赵琦峰.肺动脉灌注对慢性阻塞性肺疾病患者接受体外循环心脏手术肺保护作用[J].2018,(1).
[13]胡杰,苏新娟,郑海涛,等.右美托咪定对体外循环下冠脉旁路移植术患者心肺功能的影响[J].2017,(9).
[14]Mohammad Ali, Sheikhi,Ahmad, Ebadi,Alireza, Shahriary,etc.Cardiac Surgery Anesthesia And Systemic Inflammatory Response.[J].2015,4(2).
[15]Borger,M.A.,Kaeding,A.F.,Seeburger,J.,etc.Minimally invasive mitral valve repair in Barlow's disease: Early and long-term results[J].2014,148(4).
[16]M. Assicot,C. Bohuon,D. Gendrel,etc.High serum procalcitonin concentrations in patients with sepsis and infection[J].1993,341(8844).
[17]Arnold JH,Blackstone EH,Smedira NG,etc.Durability of mitral valve repair for degenerative disease.[J].1998,116(5).
[18]Shahian DM,Smith PK,Byrne JG,etc.Special Articles: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.[J].2012,114(1).
[19]Iung, Bernard,Vahanian, Alec.Epidemiology of Acquired Valvular Heart Disease[J].2014,30(9).
[20]Arora,R.C.,Hiebert,B.M.,Arenson,B.G.,etc.Effect of intensive care unit environment on in-hospital delirium after cardiac surgery[J].2013,146(1).
[21]Kerbaul F,Guidon C,Mesana T,etc.Hyperprocalcitonemia is related to noninfectious postoperative severe systemic inflammatory response syndrome associated with cardiovascular dysfunction after coronary artery bypass graft surgery.[J].2002,16(1).
[22]Daon, Emmanuel,Flynn, Brigid C.,Richey, Matthew,etc.Implementation of an Early Extubation Protocol in Cardiac Surgical Patients Decreased Ventilator Time But Not Intensive Care Unit or Hospital Length of Stay[J].2018,32(2).
[23]Kalkman CJ,van-Dijk D,Brandon-Bravo-Bruinsma GJ,etc.Fast-track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients.[J].2009,108(3).
[24]Arif Tarhan,Fikri Yapici,Azmi Ozler,etc.Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state.[J].2011,14(2).
[25]Bernard Uzzan.Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: A systematic review and meta-analysis.[J].2006,34(7).
[26]Samira, Rajaei,Ali, Dabbagh.Risk factors for postoperative respiratory mortality and morbidity in patients undergoing coronary artery bypass grafting.[J].2012,2.
[27]Madhav Bhatia,Shabbir Moochhala.Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome[J].2004,202(2).
[28]M. Ueki,T. Kawasaki,K. Habe,etc.The effects of dexmedetomidine on inflammatory mediators after cardiopulmonary bypass[J].2014,69(7).
[29]Patrick Perier,Janet Martin,Avtar Lal,etc.Minimally Invasive Versus Conventional Open Mitral Valve Surgery A Meta-Analysis and Systematic Review[J].2011,6(2).
[30]Piroze M, Davierwala,Joerg, Seeburger,Bettina, Pfannmueller,etc.Minimally invasive mitral valve surgery: "The Leipzig experience".[J].2013,2.
[31]Murat Güvener,Oktay Korun,Orhan Saim Demirtürk.Risk Factors for Systemic Inflammatory Response After Congenital Cardiac Surgery[J].2015,30(1).
[32]Vasilis A, Constantinides,Paris P, Tekkis,Azeem, Fazil,etc.Fast-track failure after cardiac surgery: development of a prediction model.[J].2006,34(12).
[33]Wendy K, Bernstein,Andrew, Walker.Anesthetic issues for robotic cardiac surgery.[J].1900,18.
[34]C, Hammerstingl,R, Schueler,A, Welz,etc.[Ischemic mitral regurgitation: pathomechanisms and current therapeutic options].[J].2013,54(1).
[35]David Warltier,Paul Myles,David Daly,etc.A Systematic Review of the Safety and Effectiveness of Fast-track Cardiac Anesthesia[J].2003,99(4).
[36]Ender J,Borger MA,Scholz M,etc.Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept.[J].2008,109(1).
[37]Karaman, Yucel,Abud, Burcin,Tekgul, Zeki Tuncel,etc.Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting[J].2015,29(4).
[38]N M H, Bulow,E, Colpo,R P, Pereira,etc.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass.[J].2016.
[39]Christina, Wacker,Anna, Prkno,Frank M, Brunkhorst,etc.Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis.[J].2013,13(5).