颅脑术后患者气管拔管期安全性的影响因素分析  

Influencing factors for safety during endotracheal extubation after craniotomy

作　　者：汪睿 李卫娜 张超 张燕春 李雨泓 王霞 谭彬彬 杨雪 刘艳 陈图南 鲜继淑 WANG Rui;LI Weina;ZHANG Chao;ZHANG Yanchun;LI Yuhong;WANG Xia;TAN Binbin;YANG Xue;LIU Yan;CHEN Tunan;XIAN Jishu(Department of Neurosurgery,Army Medical University(Third Military Medical University),Chongqing,40038,China;Department of Army Aviation Medicine,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,40038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院神经外科,重庆400038 [2]陆军军医大学(第三军医大学)第一附属医院航空医学教研室,重庆400038

出　　处：《陆军军医大学学报》2023年第19期2074-2080,共7页Journal of Army Medical University

基　　金：重庆英才青年拔尖人才项目(414ZD46)。

摘　　要：目的探讨神经外科颅脑术后患者气管拔管期安全性现状及拔管相关危险因素。方法采用前瞻性队列研究,纳入2022年2-10月在本院神经外科经颅脑术后气管插管的60例患者。其中男性19例(31.7%),女性41例(68.3%),年龄为18~75(47.2±15.7)岁。以拔管期血流动力学和呼吸氧合指标是否安全为结局指标,收集围术期、拔管期相关临床资料。采用单因素和多因素Logistic回归分析筛选出拔管期安全性的影响因素。结果共纳入60例患者,拔管不安全发生率36.7%。单因素二元Logistic回归分析结果示拔管期安全性的影响因素有:体质量指数(OR=1.12,95%CI:0.96~1.31)、吸烟史(OR=5.29,95%CI:0.93~30.11)、拔管前镇静镇痛(OR=2.47,95%CI:0.76~8.10)、苏醒方式(OR=3.22,95%CI:1.05~9.89)、拔管舒适性(OR=4.09,95%CI:1.31~12.81)、置管时长(<24 h)(OR=4.68,95%CI:1.43~15.32,P<0.2)。多因素二元Logistic回归分析发现自主苏醒(OR=10.91,95%CI:2.05~58.04)、拔管不舒适(OR=6.68,95%CI:1.42~31.48)、置管时长<24 h(OR=4.65,95%CI:1.07~20.17)是影响拔管期安全性的独立危险因素(P<0.05)。结论颅脑术后患者气管拔管不安全风险较高,苏醒方式、拔管舒适性及置管时长可能影响患者拔管的安全性。Objective To investigate the current status and risk factors of endotracheal extubation safety after craniotomy.Methods A prospective cohort trial was carried out on 60 patients with endotracheal intubation after craniotomy in the neurosurgical department of our hospital from February to October 2022.There were 19 males(31.7%)and 41 females(68.3%),at an age from 18 to 75(47.2±15.7)years.The primary outcome was extubation safety based on hemodynamic and respiratory parameters.The clinical data during perioperative and extubation periods were collected.Univariate and multivariate logistic regression analyses were used to screen out the influencing factors for extubation safety.Results Among the 60 subjected patients,the incidence of unsafe extubation was 36.7%(22 cases).Univariate analysis using binary logistic regression showed that the factors affecting the safety of extubation were BMI(OR=1.12,95%CI:0.96~1.31),smoking history(OR=5.29,95%CI:0.93~30.11),sedation and analgesia before extubation(OR=2.47,95%CI:0.76~8.10),methods of waking up from anesthesia(OR=3.22,95%CI:1.05~9.89),comfort of extubation(OR=4.09,95%CI:1.31~12.81),and duration of intubation(OR=4.68,95%CI:1.43~15.32).Multivariate logistic regression analysis found that the independent risk factors for the safety included spontaneous awakening(OR=10.91,95%CI:2.05~58.04),uncomfortable extubation(OR=6.68,95%CI:1.42~31.48)and duration of intubation 24 h(OR=4.65,95%CI:1.07~20.17).Conclusion The endotracheal extubation after craniotomy is at high risk of unsafety.Methods of waking up from anesthesia,comfort during extubation,and duration of intubation may influence the safety of extubation.

关 键 词：颅脑手术 全麻术后 气管拔管期安全性 影响因素 

分 类 号：R181.32[医药卫生—流行病学] R473.6[医药卫生—公共卫生与预防医学] R651.11