全身麻醉后再次气管插管的危险因素及预后分析  

Risk Factors and Prognosis of Reintubation Following Surgeries under General Anesthesia

作　　者：王戡[1] 尹毅青[1] 

机构地区：[1]中日友好医院麻醉科,北京100029

出　　处：《中国医学科学院学报》2017年第1期145-149,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的分析全身麻醉后患者在恢复室发生再次气管插管的危险因素及预后。方法回顾性分析2013年10月至2014年10月在中日友好医院接受全身麻醉的14 407例患者的临床资料,根据在恢复室是否发生再次气管插管将患者分为再次插管组和对照组,对组间差异有统计学意义的因素进行多因素Logistic回归分析,寻找再次气管插管的危险因素,并分析其预后。结果 14 407例患者中,有16例发生再次气管插管。多因素Logistic回归分析结果显示,术前合并慢性阻塞性肺疾病(COPD)(OR=17.55,95%CI:3.08~59.84,P=0.001)及冠心病(OR=5.98,95%CI:1.67~21.42,P=0.006)、术中出血量大于12 ml·kg-1(OR=27.83,95%CI:10.75~54.62,P<0.001)和胸内手术(OR=22.96,95%CI:12.66~48.19,P=0.004)是再次气管插管的危险因素。结论术前合并COPD及冠心病、术中出血量大于12 ml·kg-1和胸内手术是全身麻醉后发生再次气管插管的危险因素,且大部分患者预后良好。Objective To investigate the independent risk factors and the prognosis of reintubation following surgeries under general anesthesia in post-anesthesia care unit（ PACU）. Methods We retrospectively analyzed the clinical data of 14 407 patients undergoing elective surgeries from October 2013 to October 2014 in the China-Japanese Friendship Hospital. Patients were divided into reintubation group and control group according to the application of reintubation（ or not） in PACU. Multivariate Logistic analysis was performed for factors showing significant difference between these two groups to screen for risk factors and analyze the prognosis.Results Sixteen patients（ 0. 11 %） were reintubated in PACU. The Logistic regression analysis showed that the independent risk factors for reintubation were as following： preoperative chronic obstructive pulmonary disease（COPD）（ OR = 17. 55,95% CI ： 3. 08-59. 84,P = 0. 001） or preoperative coronary artery disease（ OR =5. 98,95 % CI ： 1. 67-21. 42, P = 0. 006）, intraoperative blood loss greater than 12 ml· kg^- 1（OR = 27. 83,95 % CI ： 10. 75-54. 62, P〈0. 001）, and thoracic surgery（ OR = 22. 96, 95 % CI ： 12. 66-48. 19, P =0. 004）. Conclusions Preoperative COPD or coronary artery disease, intraoperative blood loss greater than12 ml· kg^- 1,and thoracic surgery are the independent risk factors for postoperative PACU reintubation of patients undergoing surgeries with general anesthesia. Although the mortality rate is relative high, most patientshave a good prognosis.

关 键 词：全身麻醉 恢复室 再次气管插管 危险因素 预后 

分 类 号：R614[医药卫生—麻醉学]