病态肥胖患者腹腔镜减肥手术后早期拔管的影响因素分析

Possible influence factors for early extubation after laparoscopic bariatric surgery in morbid obese patients

目的研究影响病态肥胖患者腹腔镜减肥手术后早期拔管的因素。方法收集2007年1月至2013年6月在北京协和医院实施的全麻腹腔镜减肥手术39例患者的麻醉相关资料,根据手术后拔管时间不同将患者分为手术室内拔管返PACU组(PACU组,17例)和延迟拔管返ICU组(ICU组,22例)。采用独立样本t检验或χ2检验比较两组患者的人口学资料、术前合并症和麻醉用药等,非条件Logistic回归模型分析早期拔管的影响因素。结果共有39例病态肥胖患者入组,ICU组患者的年龄、BMI、高血压和阻塞性睡眠呼吸暂停综合征(OSA)的发生率明显高于PACU组(P<0.05),其中BMI和睡眠呼吸紊乱指数(AHI)是影响术后是否能够早期拔管的危险因素。结论病态肥胖患者的BMI和OSA的严重程度可能是影响术后是否能够早期拔管的重要因素。

Objective This study was to evaluate the anesthesia management of morbid obese patients undergoing bariatric surgery,including the incidence of difficult airway and the possible influencing factors of early tracheal extubation.Methods Patients who received laparoscopic bariatric surgery under general anesthesia in PUMCH from January 2007 to June 2013 were enrolled.The incidence of difficult airway was analyzed.The patients were divided into two groups according to whether extubation was carried out in the operating room（group PACU,n=17）or in ICU（group ICU,n=22）.Geographic data,preoperative comorbidities,dose of anesthetics,duration of surgery,ventilation and fluid management were analyzed and compared between two groups.Results Thirty-nine morbid obese patients were intubated successfully with either Masintosh laryngoscope or Glidescope.No difficult ventilation was encountered.Age,BMI,and incidence of comorbidities including hypertension and occlusive sleep apnea（OSA）were significantly higher in group ICU than in group PACU（P〈0.05）.Logistic analysis showed that the BMI and AHI were the possible influencing factors of early extubation.There were no differences in the dose of anesthetics and duration of surgery between two groups.Conclusion Patients＇ BMI and the severity of OSA were the possible influencing factors of early extubation.