摘要
目的 分析肝移植术后气管导管延迟拔管的影响因素.方法 回顾收集2020年9月1日至2023年3月31日期间在东部战区总医院全身麻醉下行肝移植手术患者的病历资料,根据拔管时间分成为3组,3 h内拔管为早期拔管组、3～24 h之间拔管为延迟拔管组、24 h仍未拔管为拔管困难组.比较3组肝移植受者的临床资料,采用单因素分析和多因素Cox回归分析肝移植术后拔管时间延长的危险因素.结果 共纳入237例患者,早期拔管组82例(34.60%)、延迟拔管组119例(50.21%)、拔管困难组36例(15.19%).单因素分析结果表明3组之间年龄、体重指数(body mass index,BMI)、Child-Pugh评分、MELD评分、无肝期时间、肌松药类型、术中平均体温、再灌注后最低体温具有统计学差异(P<0.05).多因素Cox回归分析结果显示年龄增加(HR=0.980,95%CI=0.966～0.994,P=0.005)、高MELD评分(HR=0.966,95%CI= 0.941～0.991,P=0.009)、术中泵注罗库溴铵是术后拔管时间延长的因素,顺式阿曲库铵与罗库溴铵相比(HR = 1.834,95%CI = 1.244～2.703,P = 0.002)、米库溴铵与罗库溴铵相比(HR = 1.660,95%CI = 1.073～2.567,P=0.023),平均体温升高(HR=2.447,95%CI=1.449～4.132,P=0.001)和再灌注后最低体温较高(HR=1.288,95%CI=1.023～1.622,P=0.031)为有利于拔管时间缩短.平均体温升高(HR= 2.447,95%CI=1.449～4.132,P=0.001)和再灌注后最低体温较高(HR=1.288,95%CI=1.023～1.622,P=0.031)为有利于拔管时间缩短.结论 年龄增加、高MELD评分、术中泵注罗库溴铵是术后气管导管拔管时间延长的因素,术中使用顺式阿曲库铵、米库溴铵和积极体温保护有利于术后快速拔管.
Abstract
Objective To analyze the factors affecting the delayed extubating of endotracheal intubation after liver transplantation.Methods The medical records of liver transplantation patients under general anesthesia in Eastern Theater General Hospital from September 1,2020 to March 31,2023 were collected retrospectively.According to the extubating time,they were divided into the early extubating group within 1 h after extubating and the delayed extubating group within 3 h after extubating.,Extubating difficult group extubating 24 h without extubating.The clinical data of the three groups of liver transplant recipients were compared,and the risk factors of prolonged extubating time after liver transplantation were analyzed by univariate analysis and multivariate Cox regression analysis.Results A total of 237 patients were included,including 82 cases(34.60%)in the early extubating group,119 cases(50.21%)in the delayed extubating group,and 36 cases(15.19%)in the difficult extubating group.The results of univariate analysis showed statistical differences in age,body mass index(BMI),Child-Pugh score,MELD score,duration of liver-free period,type of inotropes,mean intraoperative body temperature,and minimum body temperature after reperfusion between the three groups(P<0.05).Multifactorial Cox regression analysis showed that increased age(HR=0.980,95%CI= 0.966～0.994,P=0.005),high MELD score(HR=0.966,95%CI=0.941～0.991,P=0.009),and intraoperative pumping of rocuronium were independent risk factors for delayed postoperative extubating,and cis-atracurium compared with rocuronium(HR=1.834,95%CI=1.244～2.703,P=0.002),and meclizine compared with rocuronium(HR= 1.660,95%CI=1.073～2.567,P=0.023).Higher mean body temperature(HR=2.447,95%CI=1.449～4.132,P=0.001)and higher minimum body temperature after reperfusion(HR=1.288,95%CI=1.023～1.622,P=0.031)were in favor of shorter extubating time.Conclusion Increasing age,high MELD score,and intraoperative pumping of rocuronium were independent risk factors for delayed postoperative extubating,and intraoperative use of cis-atracurium,vecuronium,and aggressive temperature protection favored rapid postoperative extubating.
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