留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

头颈部手术后非计划二次插管危险因素分析

陈思 张越伦 车璐 申乐 黄宇光

陈思, 张越伦, 车璐, 申乐, 黄宇光. 头颈部手术后非计划二次插管危险因素分析[J]. 协和医学杂志, 2020, 11(6): 715-719. doi: 10.3969/j.issn.1674-9081.2020.06.014
引用本文: 陈思, 张越伦, 车璐, 申乐, 黄宇光. 头颈部手术后非计划二次插管危险因素分析[J]. 协和医学杂志, 2020, 11(6): 715-719. doi: 10.3969/j.issn.1674-9081.2020.06.014
CHEN Si, ZHANG Yue-lun, CHE Lu, SHEN Le, HUANG Yu-guang. Risk Factors for Unplanned Reintubation after Head and Neck Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 715-719. doi: 10.3969/j.issn.1674-9081.2020.06.014
Citation: CHEN Si, ZHANG Yue-lun, CHE Lu, SHEN Le, HUANG Yu-guang. Risk Factors for Unplanned Reintubation after Head and Neck Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 715-719. doi: 10.3969/j.issn.1674-9081.2020.06.014

头颈部手术后非计划二次插管危险因素分析

doi: 10.3969/j.issn.1674-9081.2020.06.014
详细信息
    通讯作者:

    申乐  电话:010-69152026, E-mail: pumchshenle@aliyun.com

  • 中图分类号: R614.2

Risk Factors for Unplanned Reintubation after Head and Neck Surgery

More Information
  • 摘要:   目的  探讨头颈部手术后非计划二次插管的危险因素。  方法  回顾性分析2014年1月1日至2018年12月31日于北京协和医院行头颈部手术患者的临床资料。以术后非计划二次插管患者为研究组,随机抽取一定量的成功拔管者为对照组,研究组与对照组患者比例为1:4。多因素Logistic回归分析头颈部手术后非计划二次插管的危险因素。  结果  共60例(研究组12例,对照组48例)符合纳入和排除标准的患者入选本研究。多因素Logistic回归分析结果显示,有全身麻醉史(OR=9.17, 95% CI:1.05~83.33, P=0.045)、Cormack-Lehane分级Ⅲ级(OR=18.87, 95% CI:1.53~250.00, P=0.022)、术中液体负荷≥20 mL/kg(OR=27.78, 95% CI:1.94~500.00, P=0.014)是头颈部手术后非计划二次插管的危险因素。研究组术后住院时间[7(3.0,17.0)d比2(2.0,5.0)d,P=0.013]、ICU停留时间[1(0.0,2.8)d比0(0.0,0.0)d,P<0.001]均长于对照组。  结论  头颈部手术后非计划二次插管与有/无全身麻醉史、Cormack-Lehane分级及术中液体负荷有关,其发生不利于患者术后康复。
    作者贡献:  陈思负责数据收集、文章撰写; 张越伦主导数据分析、研究设计; 车璐参与文献检索、数据收集; 申乐指导研究设计、结果分析、文章修改; 黄宇光参与文章审阅及修改。
    利益冲突:  无
  • 表  1  头颈部手术后非计划二次插管的单因素分析

    指标 研究组(n=12) 对照组(n=48) OR值(95% CI)
    年龄>65岁[n(%)] 3(25.0) 2(4.2) 7.69(1.12~52.63)
    男性[n(%)] 5(41.7) 21(43.8) 0.92(0.26~3.31)
    BMI(x±s, kg/m2) 26.4±1.9 23.9±0.6 2.54(-0.62~5.70)
    ASA分级≥2级[n(%)] 10(83.3) 24(50.0) 5.00(0.99~2.50)
    吸烟史[n(%)] 4(33.3) 7(14.6) 2.93(0.69~12.35)
    心脏疾病史[n(%)] 1(8.3) 2(4.2) 2.09(0.17~25.00)
    卒中史[n(%)] 4(33.3) 1(2.1) 23.26(2.32~250.00)
    哮喘/COPD史[n(%)] 0(0) 2(4.2) 1.04(0.98~1.11)
    全身麻醉史[n(%)] 9(75.0) 12(25.0) 9.00(2.09~38.46)
    Cormack-Lehane分级[n(%)]
      Ⅰ级 5(41.7) 35(72.9)
      Ⅱ级 3(25.0) 12(25.0) 1.75(0.36~8.47)
      Ⅲ级 4(33.3) 1(2.1) 27.78(2.58~333.33)
    麻醉医师年资>10年[n(%)] 5(41.7) 33(68.8) 0.32(0.09~1.19)
    术中液体负荷[n(%)]
    <20 mL/kg 3(25.0) 38(79.2)
      20~40 mL/kg 1(8.3) 1(2.1) 12.66(0.62~250.00)
      >40 mL/kg 8(66.7) 9(18.8) 11.24(2.48~50.00)
    术前WBC异常[n(%)] 3(25.0) 6(12.5) 2.33(0.49~11.12)
    术前Hb低于正常值[n(%)] 1(8.3) 0(0) 1.09(0.92~1.29)
    术前Ccr<70 mL/min[n(%)] 5(41.7) 3(6.3) 10.75(2.08~55.56)
    BMI:体质量指数; ASA:美国麻醉医师协会; COPD:慢性阻塞性肺疾病; WBC:白细胞; Hb:血红蛋白; Ccr:内生肌酐清除率
    下载: 导出CSV

    表  2  头颈部手术后非计划二次插管的多因素Logistic回归分析

    指标 β Wald χ2 OR 95% CI P
    年龄>65岁 1.96 1.30 7.09 0.25~200.00 0.254
    ASA分级≥2级 2.30 2.01 9.90 0.41~250.00 0.157
    有全身麻醉史 2.22 4.00 9.17 1.05~83.33 0.045
    Cormack-Lehane分级Ⅲ级 2.93 5.26 18.87 1.53~250.00 0.022
    术中液体负荷≥20 mL/kg 3.33 5.98 27.78 1.94~500.00 0.014
    ASA:同表 1
    下载: 导出CSV
  • [1] Ramachandran SK, Nafiu OO, Ghaferi A, et al. Indepen-dent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery[J]. Anesthesiology, 2011, 115:44-53. doi:  10.1097/ALN.0b013e31821cf6de
    [2] Fujii E, Fujino K, Tanaka-Mizuno S, et al. Variation of Risk Factors for Cause-Specific Reintubation: A Preliminary Study[J]. Can Respir J, 2018, 2018:3654251. doi:  10.1155/2018/3654251.
    [3] Jaber S, Quintard H, Cinotti R, et al. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures[J]. Crit Care, 2018, 22:236. doi:  10.1186/s13054-018-2150-6
    [4] Lin PH, Chen CF, Chiu HW, et al. Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit: A STROBE-compliant case-control study[J]. Medicine (Baltimore), 2019, 98:e14841. doi:  10.1097/MD.0000000000014841
    [5] Brovman EY, Steen TL, Urman RD. Associated risk factors and complications in vascular surgery patients requiring unplanned postoperative reintubation[J]. J Cardiothorac Vasc Anesth, 2017, 31:554-561. doi:  10.1053/j.jvca.2016.11.013
    [6] Cavallone LF, Vannucci A. Extubation of the difficult airway and extubation failure[J]. Anesth Analg, 2013, 116:368-383. doi:  10.1213/ANE.0b013e31827ab572
    [7] Michetti CP, Griffen MM, Teicher EJ, et al. FRIEND or FOE: A prospective evaluation of risk factors for reintubation in surgical and trauma patients[J]. Am J Surg, 2018, 216:1056-1062. doi:  10.1016/j.amjsurg.2018.07.004
    [8] Dos Reis HFC, Gomes-Neto M, Almeida MLO, et al. Development of a risk score to predict extubation failure in patients with traumatic brain injury[J]. J Crit Care, 2017, 42:218-222. doi:  10.1016/j.jcrc.2017.07.051
    [9] Maggiore SM, Battilana M, Serano L, et al. Ventilatory support after extubation in critically ill patients[J]. Lancet Respir Med, 2018, 6:948-962. doi:  10.1016/S2213-2600(18)30375-8
    [10] Charters P, Ahmad I, Patel A, et al. Anaesthesia for head and neck surgery: United Kingdom National Multidisci-plinary guidelines[J]. J Laryngol Otol, 2016, 130: S23-S27.
    [11] Lin HT, Ting PC, Chang WY, et al. Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: a single-center retrospective case-controlled study in Taiwan from 2005 to 2009[J]. Acta Anaesthesiol Taiwan, 2013, 51: 3-9. doi:  10.1016/j.aat.2013.03.004
    [12] Ting PC, Chou AH, Yang MW, et al. Postoperative reintubation after planned extubation: a review of 137, 866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan[J]. Acta Anaesthesiol Taiwan, 2010, 48:167-171. doi:  10.1016/j.aat.2010.12.003
    [13] Rujirojindakul P, Geater AF, McNeil EB, et al. Risk factors for reintubation in the post-anaesthetic care unit: a case-control study[J]. Br J Anaesth, 2012, 109:636-642. doi:  10.1093/bja/aes226
    [14] Cheng AC, Cheng KC, Chen CM, et al. The outcome and predictors of failed extubation in intensive care patients-the elderly is an important predictor[J]. Int J Gerontol, 2011, 5:206-211. doi:  10.1016/j.ijge.2011.09.021
    [15] Attaallah AF, Vallejo MC, Elzamzamy OM, et al. Perioperative risk factors for postoperative respiratory failure[J]. J Perioper Pract, 2019, 29:49-53. doi:  10.1177/1750458918788978
    [16] Acheampong D, Guerrier S, Lavarias V, et al. Unplanned postoperative reintubation following general and vascular surgical procedures: Outcomes and risk factors[J].Ann Med Surg (Lond), 2018, 33: 40-43. doi:  10.1016/j.amsu.2018.08.013
    [17] Hahn RG. Adverse effects of crystalloid and colloid fluids[J]. Anaesthesiol Intensive Ther, 2017, 49:303-308. http://europepmc.org/abstract/MED/28953310
    [18] 黄薇, 张宏民, 王小亭, 等.容量管理认识面面观[J].协和医学杂志, 2019, 10:450-455. doi:  10.3969/j.issn.1674-9081.2019.05.005

    Huang W, Zhang HM, Wang XT, et al. The Principles of Volume Management[J]. Xie He Yi Xue Za Zhi, 2019, 10:450-455. doi:  10.3969/j.issn.1674-9081.2019.05.005
    [19] 王戡, 尹毅青.全身麻醉后再次气管插管的危险因素及预后分析[J].中国医学科学院学报, 2017, 39: 145-149. doi:  10.3881/j.issn.1000-503X.2017.01.024

    Wang K, Yin YQ. Risk Factors and Prognosis of Reintuba-tion Following Surgeries under General Anesthesia[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2017, 39: 145-149. doi:  10.3881/j.issn.1000-503X.2017.01.024
    [20] Andrade RG, Lima BL, Lopes DK, et al. Difficult laryngoscopy and tracheal intubation: observational study[J].Braz J Anesthesiol, 2018, 68:168-173. doi:  10.1016/j.bjan.2017.10.009
    [21] Suraseranivong R, Krairit O, Theerawit P, et al. Association between age-related factors and extubation failure in elderly patients[J]. PLoS One, 2018, 13:e0207628. doi:  10.1371/journal.pone.0207628
  • 加载中
表(2)
计量
  • 文章访问数:  317
  • HTML全文浏览量:  63
  • PDF下载量:  15
  • 被引次数: 0
出版历程
  • 收稿日期:  2019-07-31
  • 录用日期:  2019-10-16
  • 网络出版日期:  2019-10-22
  • 刊出日期:  2020-11-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!