肺叶切除术后拔管延迟危险因素分析

Analysis of Risk Factors of Delayed Extubation after Lobectomy

目的:探讨肺叶切除术后气管插管拔管延迟的危险因素。方法:回顾性分析2012年6月-2020年6月在本院接受肺叶切除术的101例患者的临床资料。根据术后拔管时间,将患者分为延迟拔管组(A组)28例,正常拔管组(B组)73例。分析两组患者围术期相关资料,采用多因素logistic回归分析肺叶切除术后拔管延迟的危险因素。结果:两组性别、疾病类型、血红蛋白、麻醉时间、阿片类药物使用、通气方式、是否使用吸入麻醉比较,差异均无统计学意义(P>0.05);两组年龄、BMI、吸烟史、肺功能、单肺通气时间、输血量、尿量比较,差异均有统计学意义(P<0.05)。通过多因素非条件logistic回归分析发现,年龄>60岁、BMI>25 kg/m^(2)、术前中度或重度肺通气功能障碍、单肺通气时间>120 min、尿量≤17 mL/h、输血量>2000 mL是肺叶切除术后患者延迟拔管的独立危险因素(P<0.05)。B组术后住院时间明显短于A组,术后肺炎、心律失常发生率均低于A组,差异均有统计学意义(P<0.05)。结论:通过分析肺叶切除术后气管插管拔管延迟的危险因素,术前可筛选出高危患者,更好地进行围手术期准备,减少术后并发症发生率,缩短住院时间。

Objective:To investigate the risk factors of delay in extubation after lobectomy.Method:The clinical data of 101 patients who underwent lobectomy in our hospital from June 2012 to June 2020 were analyzed retrospectively.According to postoperative extubation time,the patients were divided into 28 cases in delayed extubation group(group A)and 73 cases in normal extubation group(group B).The perioperative related data of the two groups were analyzed,the risk factors of extubation delay after lobectomy were analyzed by multivariate logistic regression.Result:Comparison of sex,disease type,hemoglobin,anesthesia time,opioid use,ventilation mode and whether inhalation anesthesia was used between the two groups,there were no significant differences(P>0.05).Comparison of age,BMI,smoking history,lung function,duration of one-lung ventilation,blood transfusion volume and urine volume between the two groups,the differences were statistically significant(P<0.05).Multivariate unconditional logistic regression analysis showed that age>60 years old,BMI>25 kg/m^(2),preoperative moderate or severe pulmonary ventilation dysfunction,single lung ventilation time>120 min,urine volume≤17 mL/h and blood transfusion volume>2000 mL were independent risk factors for delayed extubation after lobectomy(P<0.05).The postoperative hospitalization time in group B was significantly shorter than that in group A,the incidences of postoperative pneumonia and arrhythmia were lower than those in group A,the differences were statistically significant(P<0.05).Conclusion:By analyzing the risk factors of delayed tracheal intubation and extubation after lobectomy,high-risk patients can be screened out before operation,better perioperative preparation,reduce the incidence of postoperative complications,shorten hospital stay.