乳腺肿瘤患者术后雾化吸入治疗危险因素分析

Analysis of the risk factors for atomization inhalation after breast cancer surgery

目的探究乳腺肿瘤患者行全身麻醉术后雾化吸入治疗的危险因素。方法回顾性分析我院2014年1月至2016年6月2 431例全身麻醉下行乳腺肿瘤手术患者的临床资料,采用χ~2检验及Logistic回归分析术后雾化吸入治疗的危险因素。结果 2 431例患者中,术后接受雾化吸入治疗1 157例(47.6%),χ~2检验单因素分析结果:年龄≥65岁(P<0.05)、BMI>25 kg/m^2(P<0.05)、ASA分级的增加(P<0.05)、术前合并呼吸道疾病(P<0.05)、高血压病史(P<0.05)、糖尿病病史(P<0.05)、气管插管(P<0.05)、手术时间>2 h(P<0.05)是乳腺肿瘤手术患者术后雾化吸入治疗的危险因素,将上述因素纳入二项分类Logistic回归分析显示,年龄≥65岁(OR=13.66,95%CI 9.05~20.62)、BMI>25 kg/m^2(OR=6.47,95%CI 4.30~9.74)、ASA分级增加(OR=1.90,95%CI 1.50~2.41)、术前合并呼吸道疾病(OR=2.86,95%CI 1.88~4.34)、气管插管(OR=12.00,95%CI 9.00~16.01)、手术时间>2 h(OR=24.50,95%CI 18.06~33.25)是乳腺肿瘤手术患者术后雾化吸入治疗的独立危险因素。结论高龄、肥胖、ASA分级增加、术前合并呼吸道疾病、手术时间>2 h、气管插管会增加乳腺肿瘤患者术后呼吸道及肺部并发症的发生率,增加雾化吸入使用率。全身麻醉中采用喉罩、提高术者手术技能及科室间协同能缩短手术时间,降低患者术后呼吸道并发症的发生率,降低雾化吸入使用率。

Objective To investigate the risk factors for atomization inhalation after breast cancer surgery.Methods The clinical data of 2 431 patients who underwent breast cancer surgery under general anesthesia from January2014 to June 2016 in our hospital was analyzed retrospectively. The risk factors for atomization inhalation were analyzed by χ^2 test single-factor analysis and Logistic regression analysis. Results Totally 1 157 cases（ 47. 6%） received atomization inhalation after breast cancer surgery. The results of single-factor analysis showed that age≥ 65 years old（ P〈0. 05）,Body Mass Index（ BMI） 25 kg/m^2（ P 0. 05）, the increase of the American Society of Anesthesiologists（ ASA） classification（ P〈0. 05）, combination with respiratory diseases before surgery（ P〈0. 05）,hypertension history（ P〈0. 05）,diabetic history（ P〈0. 05）, tracheal intubation（ P〈0. 05） and operation time 2 h（ P〈0. 05）were the risk factors for atomization inhalation after breast cancer surgery. Logistic regression analysis with above factors classified into two categories showed that age≥65 years old（ OR = 13. 66, 95%CI 9. 05 ～ 20. 62）,BMI 25 kg/m^2（ OR = 6. 47, 95%CI 4. 30 ～ 9. 74）, the increase of ASA classification（ OR = 1. 90, 95%CI 1. 50 ～ 2. 41）, combination with respiratory diseases before surgery（ OR = 2. 86, 95% CI 1. 88 ～ 4. 34）, tracheal intubation（ OR = 12. 00, 95% CI9. 00 ～ 16. 01）,o peration time 2 h（ OR = 24. 50, 95%CI 18. 06 ～ 33. 25） were the independent risk factors for atomization inhalation after breast cancer surgery. Conclusion Old age,obesity, the elevated ASA classification,combination with respiratory diseases, tracheal intubation and operation time 2 h can increase the incidence rate of respiratory and pulmonary complications in patients after breast cancer surgery and the application of atomization inhalation.Laryngeal mask airway, improving surgical skills and inter-department coordination can shorten the operation time,which can reduce the incidence of postoperative respiratory complications and the use of atomization inhalation.