非心脏手术后延迟拔管的危险因素分析及预测模型建立

Risk factors analysis and prediction model establishment of delayed extubation after non-cardiac surgery

目的探讨非心脏手术后延迟拔管的危险因素并建立预测模型。方法回顾性分析2020年9—10月接受非心脏手术且术后于PACU进行麻醉苏醒的1009例患者临床资料。根据术后是否出现延迟拔管将患者分为两组:延迟拔管组(拔管时间>1 h)和非延迟拔管组(拔管时间≤1 h)。采用LASSO回归和多因素Logistic回归建立预测模型,受试者工作特征(ROC)曲线、曲线下面积(AUC)和决策曲线分析评估该预测模型对非心脏手术后延迟拔管的预测价值。结果发生延迟拔管253例(25.1%)。多因素Logistic回归分析结果显示,ACCI评分(≥3分)、BMI(≤22.66 kg/m^(2))、术中罗库溴铵的使用、术中输血、手术时间(≥166 min)、留置导尿管、PACU内丙泊酚的使用和PACU内血管活性药物的使用是术后延迟拔管的独立危险因素(P<0.05)。预测模型的AUC为0.730(95%CI 0.695~0.765,P<0.001),敏感性81.4%,特异性55.4%。决策曲线分析显示,该预测模型对延迟拔管的预测具有重要临床价值。结论ACCI评分(≥3分)、BMI(≤22.66 kg/m^(2))、术中罗库溴铵的使用、术中输血、手术时间(≥166 min)、留置导尿管、PACU内丙泊酚的使用和PACU内血管活性药物的使用是非心脏手术后延迟拔管的危险因素,基于以上危险因素建立的模型具有较好的预测价值。

Objective To investigate the risk factors of delayed extubation after non-cardiac surgery and establish a predictive model.Methods Retrospective analysis of 1009 patients who underwent non-cardiac surgery and underwent postoperative anesthesia awakening in PACU from September to October 2020.The patients were divided into two groups according to whether extubation was delayed during anesthesia recovery:delayed extubation group(extubation time exceeded 1 hour)and non-delayed extubation group(extubation time did not exceed 1 hour).LASSO and multivariate logistic regression were used to establish a predictive model.Receiver operating characteristic(ROC)curve,area under the curve(AUC)and decision curve were analyzed to evaluate the predictive value of the predictive model for delayed extubation after non-cardiac surgery.Results There were 253 patients(25.1%)in the delayed extubation group.The results of multivariate Logistic regression analysis showed that ACCI score(≥3 points),BMI(≤22.66 kg/m^(2)),intraoperative use of rocuronium bromide,intraoperative blood transfusion,operative time(≥166 minutes),indwelling catheter,use of propofol in PACU,and use of vasoactive drugs in PACU were independent predictors of delayed postoperative extubation.The AUC of predictive model was 0.730(95%CI 0.695-0.765,P<0.001),and sensitivity was 81.4%,and specificity was 55.4%.The analysis of decision curve showed that this prediction model has important clinical value for the prediction of delayed extubation.Conclusion ACCI score(≥3 points),BMI(≤22.66 kg/m^(2)),intraoperative use of rocuronium bromide,intraoperative blood transfusion,operation time(≥166 minutes),indwelling catheter,use of propofol in PACU,and use of vasoactive drugs in PACU have significant predictive value for delayed extubation after general anesthesia.