退行性颈椎病颈椎前路手术后气道再插管的多因素分析

Multivariate analysis of airway re-intubation after anterior cervical spine surgery for degenerative cervical spondylopathy

[目的]探讨颈前路手术后气道阻塞再次插管的相关危险因素。[方法]回顾性研究2007年1月~2016年6月774例颈前路手术的病史及随访资料,以是否并发气道阻塞将患者分为两组,记录患者的年龄、性别、吸烟史、饮酒史、高血压、有无合并糖尿病、慢性咽炎、体重指数(body mass index,BMI)、病程时间、手术方式、术前JOA评分、手术节段位置、手术时间、术中出血量、手术节段数、术中神经损伤。将上述可能与并发气道阻塞相关的因素先行单因素分析,筛选出有统计学意义的因素再行多因素Logistic回归分析,分析其与颈前路手术后气道阻塞再插管的关系。[结果]744例患者中14例出现术后气道阻塞再插管,颈前路术后气道阻塞的发生率为1.81%(14/774)。14例颈前路术后气道阻塞再插管患者中,12例(85.71%)术后48 h内出现气道阻塞再插管,2例(14.29%)为迟发性术后气道阻塞再插管,迟发性颈前路术后气道阻塞出现时间为术后9~11 d。单因素分析结果显示两组病例在年龄、吸烟、体重指数、高血压、慢性咽炎、JOA评分、手术方式、手术节段位置、手术时间、手术节段数方面差异有统计学意义(P<0.05);多因素Logistic回归分析显示:年龄、吸烟、高血压、慢性咽炎、JOA评分、体重指数、手术时间、手术方式、节段位置及手术节段数是颈前路术后气道阻塞再插管的危险因素(P<0.05)。[结论]年龄、吸烟、体重指数、高血压、慢性咽炎、手术时间、手术方式、手术节段数及手术节段位置是诱发颈前路术后气道阻塞导致再次插管的重要因素。

[Objective] To explore the risk factors of airway re-intubation after anterior cervical surgery for airway obstruc- tion. [Method] We retrospectively analyzed the clinical data of 774 patients who underwent anterior cervical surgery from Janu- ary 2007 to June 2016. The patients were divided into two groups according to whether or not they had concurrent airway ob- struction. The age, gender, history of smoking and alcohol drinking, whether or not accompanied with hypertension, diabetes or chronic pharyngitis, body mass index （BMI）, duration of disease, surgical procedure, preoperative JOA score, the segments sur- gically involved, operative time, intraoperative blood loss, number of segments affected, and whether accompanied with intraop- erative nerve injury were compared between the two groups. In addition, a multivariate logistic regression analysis was per- formed to analyze the correlation between aforesaid factors and the re-intubation after anterior cervical surgery. [Result] Of the 744 patients, 14 patients （1.81%） suffered from airway obstruction after anterior approach surgery, including 12 patients with airway re-intubation within 48 hours after surgery, whereas 2 patients with delayed postoperative airway re-intubation due to an- terior cervical airway obstruction occurred after 9-1 ld. The results of univariate analysis showed that there were significant differences in age, smoking, BMI, hypertension, chronic pharyn- gitis, JOA score, operation mode, segments operated, opera- tion time and number of segment surgically involved be- tween the two groups （P〈O.05）. In addition, multivariate lo- gistic regression analysis showed that age, smoking, hyper- tension, chronic pharyngitis, JOA score, BMI, operationtime, operation mode, position and operation segment number were risk factors of re-intubation （P〈O.05） . [Conclusion] The age, smoking, BMI, hypertension, chronic pharyngitis, operation time, operation method, segment operated and number of seg- ments surgically involved are important correlated factors to airway re-intubation after anterior cervical surgery.