560例气管切开行机械通气患者并发气管狭窄的危险因素分析  

Analysis of the risk factors causing tracheal stenosis after tracheotomy for mechanical ventilation in 560 patients

作　　者：吴旋[1] 苏振忠[1] 胡丽茎[1] 蒋爱云[1] 文卫平[1] 雷文斌[1] 林爱华[2] 

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院 [2]中山大学公共卫生学院统计学与流行病学系

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第11期839-842,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省科技计划项目（2006B60501022）

摘　　要：目的探讨气管切开并行机械通气患者发生气管狭窄的危险因素。方法选择中山大学附属第一医院1990年1月—2006年6月气管切开并行机械通气治疗的560例患者为研究对象，就性别、年龄、术前有否气管插管、术前插管时间、术后持续机械通气时间、既往气管切开史、更换气管套管次数、环甲膜切开、呼吸道感染、糖尿病、胃食管反流等临床因素，用逐步Logistic回归进行多因素分析。结果本组560例中出现气管狭窄54例（9．6％），多因素分析结果：术前插管时间（χ^2=4.323，P=0．038）、术后持续机械通气时间（χ^2=14．062，P=0．000）、呼吸道感染（χ^2=8．604，P=0．004），糖尿病（χ^2=5．237，P=0．014）与气管狭窄发生有关。上述危险因素，按其影响的大小顺序为：机械通气时间（OR=10．818）、呼吸道感染（OR=6．349）、糖尿病（OR=3．019）、术前插管时间（OR=2．156）。结论气管切开并行机械通气患者并发气管狭窄的影响因素是多方面的。统计学研究表明，术前插管时间、术后机械通气持续时间、呼吸道感染和合并有糖尿病等是其危险因素。Objective To investigate the risk factors causing tracheal stenosis after tracheotomy for mechanical ventilation. Methods A retrospective study was carried out to review the clinical data of 560 patients who had been tracheotomy for mechanical ventilation in the First Affiliated Hospital of Sun Yat - sen University from 1990 to 2006. The clinical relevant factors causing tracheal stenosis included age, sex, preoperative intubation, preoperative intubation time, postoperative mechanical ventilation duration, airway infection, multiple changes of intubation tube, cricothyroidotomy, previous tracheotomy, gastroesophageal reflux, diabetes, etc. Multivariate stepwise logistic regression model was used for the analysis. Results Fifty- four cases （9.6%） presented tracheal stenosis in 560 patients after tracheotomy. With multivariate analysis, it was confirmed that the following variable correlated to tracheal stenosis, i. e, preoperative intabation time （ χ^2 = 4. 323, P = 0. 038 ） , postoperative mechanical ventilation duration （ χ^2 = 14. 062,P = 0. 000） ,airway infection （χ^2 =8. 604,P =0. 004） , diabetes（χ^2 =5. 237,P =0. 014）. The effect degree of these risk factors was as below, postoperative mechanical ventilation duration （OR = 10. 818）, airway infection （ OR = 6. 349 ）, diabetes （ OR = 3. 019 ） , intubation time preoperative （ OR = 2. 156 ）. Conclusions Among patients who received tracheotomy for mechanical ventilation , the clinical relevant factors causing tracheal stenosis were various. Statistical analysis showed that preoperative intubation time, postoperative mechanical ventilation duration, diabetes, airway infection were main risky factors which may cause tracheal stenosis.

关 键 词：气管切开术 气管狭窄 呼吸 人工 因素分析 统计学 

分 类 号：R459.6[医药卫生—治疗学]