Analysis Risk Factors For Prolonged Stay In Intensive Care Unit On Patients Undergoing Cardiac Valve Replacement Surgery In A Hospital

ObjectiveTo analyze risk factors for prolonged stay in intensive care unit (ICU) aftercardiac valve replacement surgery, and to provide the basis of classification diagnosisand treatment for cardiac valve replacement surgery patients.MethodsBetween January2009and December2011in the Wuhan Asia Heart hospital,695patients undergone mitral valve and aortic valve cardiac replacement surgery,1141patients undergone mitral valve replacement surgery and393patients undergone aorticvalve replacement surgery were explored, and36univariate alternative risk factors willbe analyzed separately and then the significant variables will be taken into themultivariate analysis (logistic regression) to identify the risk factors, and then selectingthe major risk factor for prolonged stay in ICU(the time stay in ICU at least3days).ResultsPart I Analysis risk factors for prolonged stay in intensive care unit on patientsundergoing double valve replacement surgeryProlonged stay in ICU is31cases, and the incidence is4.46%. Single factoranalysis showed male, pulmonary artery systolic pressure≥60mmHg, cardiopulmonarybypass time≥3h, aortic cross-clamping time≥2h, breathing machine auxiliary time≥48h,reoperation, arrhythmia, cardiopulmonary bypass support, repeat concomitant coronaryartery diseases, infective endocarditic (3months), heart with vegetations,LVEDD≥7cm, left arterial diameter≥5.0cm, and the need of using flaring intravenousdrug are the risk factors for prolonged stay in ICU. Logistic multifactor analysis resultsshowed reoperation, breathing machine auxiliary time≥48h, left atrium≥5cm,concomitant coronary artery diseases, cardiopulmonary bypass time≥3h, heartvegetations and left arterial diameter≥5.0cm are the risk factors for prolonged stay inICU.Part II Analysis risk factors for prolonged stay in intensive care unit on patientsundergoing mitral valve replacement surgery Prolonged stay in ICU is94cases, and the incidence is8.22%. Single factoranalysis showed pulmonary artery systolic pressure≥60mmHg, left ventricular electionfraction＜0.5, the type of heart valve disease, breathing machine auxiliary time≥48h,arrhythmia, cardiopulmonary bypass time, recently heart failure, the last time of theblood creatinine≥135μmol/L, left atrial diameter≥5.0cm, LVEDD≥7.0cm andLVESD≥5.0cm are the risk factors for prolonged stay in ICU.Logistic multifactor analysis results showed breathing machine auxiliarytime≥48h, arrhythmia, left arterial diameter≥5.0cm, LVEDD≥7.0cm andLVESD≥5.0cm are the major risk factors for prolonged stay in ICU.Part III Analysis risk factors for prolonged stay in intensive care unit on patientsundergoing aortic valve replacement surgeryProlonged stay in ICU is41cases, and the incidence is10.43%. Single factoranalysis showed New York Heart Association（NYHA）class III, left ventricularelection fraction＜0.5, cardiopulmonary bypass time≥3h, breathing machineauxiliary time≥48h, operative category, cardiopulmonary bypass time, Positive resultsof Blood Cultivation, left arterial diameter≥5.0cm, LVEDD≥7.0cm and LVESD≥5.0cmare the risk factors for prolonged stay in ICU.Logistic multifactor analysis results showed election fraction＜0.5,cardiopulmonary bypass time≥3h and left arterial diameter≥5.0cm are the major riskfactors for prolonged stay in ICU.ConclusionTake special measures on these risk factors especially the independent risk factors,improving cardiac and respiratory function effectively before operation, shortenduration of operation and cardiopulmonary bypass as far as possible, avoid accidentsintraoperatively, and to prevent and manage complications effectively and actively. Itwill have an important meaning to decrease the time stayed in ICU and even the earlydeath in patients after the operation.