Analysis of risk factors for diaphragmatic dysfunction after cardiovascular surgery with extracorporeal circulation: A retrospective cohort study
10.7507/1007-4848.202410012
- VernacularTitle:心脏外科体外循环术后膈肌功能不全危险因素的回顾性队列研究
- Author:
Xupeng YANG
1
,
2
;
Yi SHI
1
,
2
;
Fengbo PEI
1
,
2
;
Simeng ZHANG
1
,
2
;
Hao MA
1
,
2
;
Zengqiang HAN
1
,
2
;
Zhou ZHAO
1
,
2
;
Qing GAO
1
,
2
;
Xuan WANG
1
,
2
;
Guangpu FAN
1
,
2
Author Information
1. Department of Cardiovascular Surgery, Peking University People'
2. s Hospital, Beijing, 100044, P. R. China
- Publication Type:Journal Article
- Keywords:
Cardiac surgery;
extracorporeal circulation;
diaphragmatic dysfunction;
risk factor
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2025;32(08):1140-1145
- CountryChina
- Language:Chinese
-
Abstract:
Objective To clarify the risk factors of diaphragmatic dysfunction (DD) after cardiac surgery with extracorporeal circulation. Methods A retrospective analysis was conducted on the data of patients who underwent cardiac surgery with extracorporeal circulation in the Department of Cardiovascular Surgery of Peking University People's Hospital from January 2023 to March 2024. Patients were divided into two groups according to the results of bedside diaphragm ultrasound: a DD group and a control group. The preoperative, intraoperative, and postoperative indicators of the patients were compared and analyzed, and independent risk factors for DD were screened using multivariate logistic regression analysis. Results A total of 281 patients were included, with 32 patients in the DD group, including 23 males and 9 females, with an average age of (64.0±13.5) years. There were 249 patients in the control group, including 189 males and 60 females, with an average age of (58.0±11.2) years. The body mass index of the DD group was lower than that of the control group [(18.4±1.5) kg/m2 vs. (21.9±1.8) kg/m2, P=0.004], and the prevalence of hypertension, chronic obstructive pulmonary disease, heart failure, and renal insufficiency was higher in the DD group (P<0.05). There was no statistical difference in intraoperative indicators (operation method, extracorporeal circulation time, aortic clamping time, and intraoperative nasopharyngeal temperature) between the two groups (P>0.05). In terms of postoperative aspects, the peak postoperative blood glucose in the DD group was significantly higher than that in the control group (P=0.001), and the proportion of patients requiring continuous renal replacement therapy was significantly higher than that in the control group (P=0.001). The postoperative reintubation rate, tracheotomy rate, mechanical ventilation time, and intensive care unit stay time in the DD group were higher or longer than those in the control group (P<0.05). Multivariate logistic regression analysis showed that low body mass index [OR=0.72, 95%CI (0.41, 0.88), P=0.011], preoperative dialysis [OR=2.51, 95%CI (1.89, 4.14), P=0.027], low left ventricular ejection fraction [OR=0.88, 95%CI (0.71, 0.93), P=0.046], and postoperative hyperglycemia [OR=3.27, 95%CI (2.58, 5.32), P=0.009] were independent risk factors for DD. Conclusion The incidence of DD is relatively high after cardiac surgery, and low body mass index, preoperative renal insufficiency requiring dialysis, low left ventricular ejection fraction, and postoperative hyperglycemia are risk factors for DD.
