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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。 Abstract:Objective This study aimed to identify the risk factors for unplanned reintubation after head and neck surgery. Methods This study retrospectively investigated cases that received head and neck surgery in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2018. Patients who received unplanned reintubation after head and neck surgery were enrolled in the study group. Patients who extubated successfully were randomly sampled for the control group. The proportion of patients in the study group and the control group was 1:4. Multivariable Logistic regression analysis was used to assess the risk factors for unplanned reintubation after head and neck surgery. Results A total of 60 eligible cases (12 cases of the study group, 48 cases of the control group) meeting the inclusive and exclusive criteria were included in this study. Multivariable Logistic regression analysis revealed that general anesthesia history (OR=9.17, 95% CI: 1.05-83.33, P=0.045), Cormack-Lehane grading Ⅲ (OR=18.87, 95% CI: 1.53-250.00, P=0.022), and intraoperative fluid load ≥20 mL/kg (OR=27.78, 95% CI: 1.94-500.00, P=0.014) were risk factors for unplanned reintubation after head and neck surgery. Compared with the control group, postoperative hospital stay time[7(3.0, 17.0)d vs. 2(2.0, 5.0)d, P=0.013] and ICU stay time[1(0.0, 2.8)d vs. 0(0.0, 0.0)d, P < 0.001] of the study group were prolonged significantly. Conclusions Unplanned reintubation after head and neck surgery is associated with general anesthesia history, Cormack-Lehane grading, and intraoperative fluid load. It acts as a negative factor for patients' rehabilitation. -
Key words:
- head and neck surgery /
- unplanned reintubation /
- airway /
- general anesthesia
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 
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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值 Wald χ2值 OR值 95% CI P值 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
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