老年脊椎手术患者全麻术后再次气管插管的危险因素分析

摘要

Objective To analyze the risk factors for postoperative reintubation in the elderly patients following spinal operation under general anesthesia.Methods A retrospective study was performed on 670 patients receiving spinal surgery in our hospital from January 2010 to December 2015.According to reintubation or not after planned extubation,they were assigned into reintubation group (n=11)and non-reintubation group(n=659).The clinical data were collected and analyzed to obtain risk factors for reintubation. SPSS statistics 18.0 was used to perform the statistical analysis.Univariate and multivariate logistic regression analysis were employed for reintubation-related risk factors.Results The incidence rate of reintubation was 1.64%(11/670)in the cohort.Univariate analysis showed that gender,body mass index(BMI),physical status of American Society of Anesthesiologists(ASA)classification,preopera-tive pulse oxygen saturation(SpO2), upper respiratory infection for 2 weeks before operation, chronic obstructive pulmonary disease (COPD),emergent operation, operative sites, hemoglobin ≤90 g/L in 30 min postoperatively, and operation time were associated with reintubation after spinal surgery(P <0.05).Multivariate logistic regression analysis indicated that ASA classification ≥Ⅲ(OR=9.65,95%CI 2.362-29.384,P<0.05), operation time ≥4 h(OR=9.485,95%CI 1.620-88.002, P<0.05), and COPD(OR=13.25,95%CI 5.852-37.251,P<0.05)were risk factors for postoperative reintubation in these subjects.Conclusion ASA classification ≥Ⅲ,operation time ≥4 h, and COPD are risk factors for postoperative reintubation in the elderly patients after spinal operation under general anesthesia.%目的 分析导致老年脊椎手术患者全麻术后再次气管插管的危险因素.方法 回顾性分析中山市中医院麻醉科2010年1月至2015年12月行脊椎手术的老年患者670例,根据患者气管拔管后是否再次气管插管分为再次气管插管组11例和非气管插管组659例,记录患者基本情况并对危险因素进行分析.采用SPSS 18.0统计软件对数据进行分析,单因素和多因素logistic回归分析再次气管插管的危险因素.结果 术后需再次气管插管发生率为1.64%(11/670).单因素分析结果表明性别、体质量指数(BMI)、美国麻醉医师协会(ASA)分级、术前脉搏氧饱和度(SpO2)、合并术前2周上呼吸道感染、慢性阻塞性肺疾病(COPD)、急诊手术、手术部位、术后30 min 血红蛋白≤90 g/L、手术时间与术后再次气管插管有关(P<0.05).多因素logistic回归分析结果表明,ASA分级≥Ⅲ(OR=9.65,95%CI 2.362~29.384,P<0.05)、手术时间≥4 h (OR=9.485,95%CI 1.620~88.002,P<0.05)、合并COPD(OR=13.25,95%CI 5.852~37.251,P<0.05)是老年脊椎手术患者全麻术后再次气管插管的危险因素.结论 ASA分级≥Ⅲ、手术时间≥4 h、合并COPD是老年脊椎手术患者全麻术后再次气管插管的危险因素.