肾移植术后气管导管延迟拔管的危险因素分析

目的 探讨肾移植患者术后气管导管延迟拔管的危险因素及对预后的影响。
方法 回顾性分析2017年1月至2020年12月全麻下肾移植手术患者的电子病历资料366例，男261例，女105例，年龄18～64岁。根据拔除气管导管时间是否超过1 h分为两组：常规组和延迟组。采用单因素分析和多因素Logistic回归分析筛选肾移植术后延迟拔管的危险因素。
结果 有80例（21.9%）患者发生延迟拔管。与常规组比较，延迟组男性比例、亲属活体移植例数明显减少（P<0.05），术前Hb、术前血钙明显降低（P<0.05），冷缺血时间、麻醉时间明显延长（P<0.05），诱导使用罗库溴铵和术中输血例数明显增加（P<0.05），液体总入量、出血量明显增多（P<0.05），拔管时间、PACU停留时间明显延长（P<0.05）。多因素Logistic回归分析显示，肾移植术后延迟拔管的独立危险因素为：术前Hb<113 g/L（OR=1.847，95%CI 1.076~3.171，P=0.026）、术前血钙<2.48 mmol/L（OR=2.293，95%CI 1.258~4.179，P=0.007）、冷缺血时间>10.5 h（OR=1.986，95%CI 1.139~3.464，P=0.016）和液体总入量>1 975 ml（OR=3.092，95%CI 1.795~5.324，P<0.001）。
结论 术前Hb<113 g/L、术前血钙<2.48 mmol/L、冷缺血时间>10.5 h、液体总入量>1 975 ml是肾移植术后延迟拔管的独立危险因素。

Risk factors of delayed extubation of endotracheal catheter following renal transplantation

Objective To identify the risk factors of delayed extubation of endotracheal catheter following renal transplantation.
Methods A retrospective study was conducted on 366 patients who undergoing renal transplantation under general anesthesia from January 2017 to December 2020, 261 males and 105 females, aged 18-64 years. According to whether the extraction time of endotracheal catheter was more than one hour, the patients were divided into routine group and delayed group. Univariate analysis and multivariate Logistic regression analysis were used to identify risk factors of delayed extubation following renal transplantation.
Results There were 80 patients (21.9%) in the delayed group. Univariate analysis showed that compared with the routine group, in delayed group, the proportion of male and the number of relative living donor transplants were significantly increased (P < 0.05), preoperative Hb and blood calcium were significantly decreased (P < 0.05), cold ischemia time and anesthesia time were significantly prolonged (P < 0.05), induction of rocuronium and intraoperative blood transfusion were significantly increased (P < 0.05). Total fluid volume and blood loss were significantly increased (P < 0.05), extubation time and PACU residence time were significantly prolonged (P < 0.05). Multivariate Logistic regression analysis showed that preoperative Hb < 113 g/L (OR = 1.847, 95% CI 1.076-3.171, P = 0.026), preoperative serum calcium < 2.48 mmol/L (OR = 2.293, 95% CI 1.258-4.179, P = 0.007), cold ischemia time > 10.5 hours (OR = 1.986, 95% CI 1.139-3.464, P = 0.016), total fluid volume > 1 975 ml (OR = 3.092, 95% CI 1.795-5.324, P < 0.001) were independent risk factors of delayed extubation following renal transplantation.
Conclusion Preoperative Hb < 113 g/L, preoperative serum calcium < 2.48 mmol/L, and cold ischemia time > 10.5 hours, total fluid volume > 1 975 ml are independent risk factors for delayed extubation following kidney transplantation.