摘要目的:探讨完全胸腔镜下二尖瓣成形术后影响6H拔管的影响因素。方法:回顾性分析我院107例行腔镜下二尖瓣成形术（MVP）患者的临床资料，根据拔管时间分成两组（术后6h内拔除气管插管分为正常组70例，大于6 h拔管的为延长组37例），对患者术前、术中、术后临床资料进行组间比较，二元logistic回归分析快通道麻醉的可能影响因素。结果:两组体外循环时间（CPB）、主动脉阻断时间（ACC）、术前肺动脉收缩压>60 mmHg、持续性房颤、合并冠心病、术中泵注右美托咪定（DEX）及术后第一天血清降钙素原（PCT）浓度有差异（ P<0.05）；logistic回归显示延迟拔管的危险因素包括术前合并有冠心病[ OR=4.020，95% CI（1.341，16.607）， P=0.023]、CPB时间延长[ OR=0.950，95% CI（0.911，0.990）， P=0.015]、以及术后PCT升高[ OR=0.799，95% CI（0.701，0.912）， P=0.001]，防止延迟拔管的保护因素是术中泵注DEX[ OR=0.309，95% CI（0.090，1.063）， P=0.042]。 结论:合并冠心病、体外时间延长、术毕PCT升高是影响胸腔镜MVP 6H内拔管的危险因素，术中泵注DEX是防止延迟拔管的保护性因素。

abstractsObjective: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.