气管插管全身麻醉下治疗性内镜逆行胰胆管造影术的安全性及患者术后不良事件发生的危险因素分析

Safety of Endoscopic Retrograde Cholangiopancreatography under Tracheal Intubation and General Anesthesia and Risk Factors of Postoperative Adverse Events

目的研究气管插管全身麻醉下治疗性内镜逆行胰胆管造影术的安全性及患者术后不良事件发生的危险因素。方法回顾性选取2020年3月—2022年3月泗洪中信医院收治的40例气管插管全身麻醉下治疗性内镜逆行胰胆管造影术患者的临床资料,根据是否发生术后不良事件进行分组,分为对照组(无术后不良事件)、观察组(发生术后不良事件),各20例。统计导致患者术后不良事件发生的相关因素。结果单因素分析结果显示,观察组患者年龄≥65岁、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅲ级、高血压史、心血管病史、脑血管病史、糖尿病史、术中出血量增加和手术时间延长占比均高于对照组,差异有统计学意义(P均<0.05)。多因素分析显示,年龄≥65岁(OR=1.865,95%CI:1.129~3.079)、ASA分级为Ⅲ级(OR=1.972、95%CI:1.247~3.119)、高血压史(OR=1.533、95%CI:1.245~1.887)、手术时间延长(OR=1.237、95%CI:1.117~1.887)、手术出血量增加(OR=1.586、95%CI:1.134~2.217)为患者术后发生不良事件的危险因素,差异有统计学意义(P均<0.05)。结论年龄、ASAⅢ级、手术时间延长、术中出血量增加以及高血压史为导致气管插管全身麻醉下治疗性内镜逆行胰胆管造影术不良事件发生的主要危险因素。

Objective To study the safety of endoscopic retrograde cholangiopancreatography under tracheal intuba⁃tion and general anesthesia and the risk factors of postoperative adverse events.Methods Retrospectively selected clinical data of 40 patients undergoing therapeutic endoscopic retrograde cholangiopancreatography under tracheal in⁃tubation and general anesthesia admitted to Sihong Zhongxin Hospital from March 2020 to March 2022.They were di⁃vided into a control group(no postoperative adverse events)and an observation group(postoperative adverse events)according to whether postoperative adverse events occurred,with 20 cases in each group.The relevant factors leading to the occurrence of postoperative adverse events were statistically analyzed.Results The results of univariate analysis showed that the proportion of patients aged≥65 years old,classification of American Society of Anesthesiologists(ASA)was gradeⅢ,hypertension history,cardiovascular history,cerebrovascular history,diabetes history,intraopera⁃tive blood loss increase and operation time extension in observation group were higher than those in control group,and the differences were statistically significant(all P<0.05).Multivariate analysis showed that age≥65 years(OR=1.865,95%CI:1.129-3.079),ASA classification wasⅢ(OR=1.972,95%CI:1.247-3.119),history of hypertension(OR=1.533,95%CI:1.245-1.887),prolonged operation time(OR=1.237,95%CI:1.117-1.887),increased blood loss(OR=1.586,95%CI:1.134-2.217)were risk factors for postoperative adverse events,and the differences were statistically significant(all P<0.05).Conclusion Age,ASA gradeⅢ,prolonged operation time,increased intraoperative blood loss and history of hypertension were the main risk factors for adverse events in endoscopic retrograde cholangiopancreatog⁃raphy under general anesthesia.