头颈部手术后非计划二次插管危险因素分析

  目的  探讨头颈部手术后非计划二次插管的危险因素。  方法  回顾性分析2014年1月1日至2018年12月31日于北京协和医院行头颈部手术患者的临床资料。以术后非计划二次插管患者为研究组，随机抽取一定量的成功拔管者为对照组，研究组与对照组患者比例为1:4。多因素Logistic回归分析头颈部手术后非计划二次插管的危险因素。  结果  共60例(研究组12例，对照组48例)符合纳入和排除标准的患者入选本研究。多因素Logistic回归分析结果显示，有全身麻醉史(OR=9.17, 95% CI:1.05~83.33, P=0.045)、Cormack-Lehane分级Ⅲ级(OR=18.87, 95% CI:1.53~250.00, P=0.022)、术中液体负荷≥20 mL/kg(OR=27.78, 95% CI:1.94~500.00, P=0.014)是头颈部手术后非计划二次插管的危险因素。研究组术后住院时间7(3.0，17.0)d比2(2.0，5.0)d，P=0.013]、ICU停留时间1(0.0，2.8)d比0(0.0，0.0)d，P＜0.001]均长于对照组。  结论  头颈部手术后非计划二次插管与有/无全身麻醉史、Cormack-Lehane分级及术中液体负荷有关，其发生不利于患者术后康复。

Risk Factors for Unplanned Reintubation after Head and Neck Surgery

  Objective  This study aimed to identify the risk factors for unplanned reintubation after head and neck surgery.  Methods  This study retrospectively investigated cases that received head and neck surgery in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2018. Patients who received unplanned reintubation after head and neck surgery were enrolled in the study group. Patients who extubated successfully were randomly sampled for the control group. The proportion of patients in the study group and the control group was 1:4. Multivariable Logistic regression analysis was used to assess the risk factors for unplanned reintubation after head and neck surgery.  Results  A total of 60 eligible cases (12 cases of the study group, 48 cases of the control group) meeting the inclusive and exclusive criteria were included in this study. Multivariable Logistic regression analysis revealed that general anesthesia history (OR=9.17, 95% CI: 1.05-83.33, P=0.045), Cormack-Lehane grading Ⅲ (OR=18.87, 95% CI: 1.53-250.00, P=0.022), and intraoperative fluid load ≥20 mL/kg (OR=27.78, 95% CI: 1.94-500.00, P=0.014) were risk factors for unplanned reintubation after head and neck surgery. Compared with the control group, postoperative hospital stay time7(3.0, 17.0)d vs. 2(2.0, 5.0)d, P=0.013] and ICU stay time1(0.0, 2.8)d vs. 0(0.0, 0.0)d, P < 0.001] of the study group were prolonged significantly.  Conclusions  Unplanned reintubation after head and neck surgery is associated with general anesthesia history, Cormack-Lehane grading, and intraoperative fluid load. It acts as a negative factor for patients' rehabilitation.