口腔颌面间隙感染患者全麻术后机械通气时间延长的危险因素分析
Retrospective analysis of risk factors for prolonged mechanical ventilation in patients with oral and maxillofacial space infections after surgery under general anesthesia
范晶娴 1吴嘉骏 1葛奎 1徐兵 1王齐 1杨天页 1王繁麟1
作者信息
- 1. 上海交通大学医学院附属第九人民医院 急诊科南部,上海 200011
- 折叠
摘要
目的:分析口腔颌面间隙感染全麻术后患者机械通气时间延长(prolonged mechanical ventilation,PMV)的危险因素.方法:回顾性分析上海交通大学医学院附属第九人民医院急诊科住院行全麻手术的口腔颌面多间隙感染患者74例.根据术后机械通气时间分为非PMV组(≤2 d)和PMV组(＞2 d).收集患者的病史资料、辅助检查及临床转归等数据,采用Logistic回归分析引起PMV的危险因素;绘制受试者工作特征曲线(ROC曲线),评估相关指标对PMV的预测价值.采用SPSS 11.5软件包对数据进行统计学分析.结果:入组患者平均年龄(62.53±17.74)岁,男46例(62.2％).术后机械通气中位时间2天,PMV组32例(43.3％).PMV组较非PMV组的术后新发肺炎率高(P=0.04),住院时间延长(P=0.01).多因素回归分析显示,存在咽旁间隙感染(OR=4.06,95％ CI:1.38～12.04,P=0.01)及术后自主呼吸试验前动脉二氧化碳分压(PaCO2)(OR=1.10,95％CI:1.02～1.18,P=0.01)是PMV的独立危险因素.PMV组前白蛋白显著低于非PMV组(P＜0.01),ROC曲线分析提示其对PMV的预测价值较好(AUC=0.772,95％ CI:0.602～0.843,P=0.01).结论:PMV不利于口腔颌面间隙感染全麻手术患者的预后,及时发现危险因素有助于临床早期干预,尽早脱机和成功拔管.
Abstract
PURPOSE:To analyze the risk factors of prolonged mechanical ventilation(PMV)in patients with oral and maxillofacial space infections(MSI)after surgery under general anesthesia.METHODS:A total of 74 patients with oral and maxillofacial multiple space infection who underwent general anesthesia in Department of Emergency,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.The medical history,results of auxiliary examinations,and clinical outcomes of patients were collected for analysis.Univariate and multivariate logistic regression analyses were performed to assess risk factors associated with PMV.Receiver operator characteristic curve(ROC curve)was performed to evaluate the predictive value of related factors for PMV.Statistical analysis was con-ducted with SPSS 11.5 software package.RESULTS:The mean age of the patients was(62.53±17.74)years,while 62.2％were male.The median duration of mechanical ventilation was 2 days and 43.3％were in PMV group.The incidence of postoperative pneumonia in PMV group was significantly higher than non-PMV group(P=0.04)and LOS was longer in PMV group(P=0.01).Multivariate analysis showed that the infections involved parapharyngeal space(OR=4.06,95％ CI:1.38-12.04,P=0.01)and arterial carbon dioxide partial pressure(PaCO2)(OR=1.10,95％ CI:1.02-1.18,P=0.01)before SBT test were independent risk factors for PMV.The serum level of prealbumin(PAB)in PMV group was significantly lower than non-PMV group(P＜0.01).ROC curve analysis showed that PAB had good predictive value for PMV,the area under the ROC curve(AUC)was 0.772(95％ CI:0.602-0.843,P=0.01).CONCLUSIONS:PMV could be detrimental to progno-sis of patients with MSI.Identifying risk factors of PMV early is conductive to clinical intervention and successful weaning after surgery.
关键词
口腔颌面间隙感染/机械通气/延迟脱机/危险因素Key words
Oral and maxillofacial space infections/Mechanical ventilation/Prolonged mechanical ventilation/Risk factor引用本文复制引用
基金项目
上海市申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC12023633)
出版年
2024
NETL
NSTL
万方数据