成人气管切开机械通气并发气管狭窄的相关因素分析

Analysis of Relevant Factors Causing Tracheal Stenosis Post-Trachectomy for Mechanical Ventilation in Adult

【目的】探讨成人气管切开并行机械通气患者并发气管狭窄的影响因素。【方法】选择本院1994-2003年气管切开并行机械通气治疗的246例患者为研究对象，就性别、年龄、术前有否气管插管，术前插管时间、术后持续机械通气时间、既往气管切开史、更换气管套管次数、环甲膜切开及反复呼吸道感染、糖尿病、胃食管返流等11个相关临床因素，用x^2检验和Logistic回归进行单因素和多因素分析。【结果】本组病例中，并发气管狭窄28例(11.4％)，相关因素的单因素分析显示：术前插管时间(P=0.025)、术后持续机械通气时间(P=0.02)、反复呼吸道感染(P＜0.001)，糖尿病(P＜0.001)，胃食管返流(P=0.026)与气管狭窄发生有关。而多因素分析结果表明：术后持续机械通气时间、糖尿病、反复呼吸道感染、胃食管返流与发生气管狭窄明显相关。【结论】气管切开并行机械通气患者并发气管狭窄的影响因素是多方面的。统计学研究表明，术后机械通气持续时间、反复呼吸道感染、胃食管返流和合并有糖尿病等是其危险因素。

[Objective] To investigate the clinical relevant factors causing tracheal stenosis after trachectomy for mechanical ventilation in adult. [Methods] A retrospective study was carried out to review the history of clinical data from 246 patients who were performed trachectomy for mechanical ventilation in The First Affiliated Hospital of Sun Yat-sen University from 1994 to 2003. we analyzed the 11 clinical relevant factors causing tracheal stenosis including sex, age, intubation preoperative, intubation time preoperative, duration of mechanical ventilate postoperative, previous trachectomy, multiple change tube, cricothyroidotomy, recurrent airway infection, diabetes, gastroesophageal reflux, etc. Univariate x^2 test and multivariate stepwise logistic regression model were used for the analysis. [Results] Twenty-eight cases （11.4%） presented tracheal stenosis in 246 patients after trachectomy. In univariate analysis, it was confirmed that the following variables correlated to tracheal stenosis： intubation time preoperative （P=0.025）, duration of mechanical ventilation postoperative （P =0.02）, recurrent airway infection （P 〈 0.001）, history of diabetes （P 〈0.001）, gastroesophageal reflux （P =0.026）. In multivariate analysis, the significant risky factors for tracheal stenosis were duration of mechanical ventilation postoperative, history of diabetes, recurrent airway infection, gastroesophageal reflux. [Conclusion] The clinical relevant factors causing tracheal stenosis post-trachectomy for mechanical ventilation were various. Statistical analysis showed that duration of mechanical ventilation postoperative, recurrent airway infection, gastroesophageal reflux and history of diabetes were main risky factors which may cause tracheal stenosis.