颅脑术后患者气管拔管期安全性的影响因素分析

汪睿; 李卫娜; 张超; 张燕春; 李雨泓; 王霞; 谭彬彬; 杨雪; 刘艳; 陈图南; 鲜继淑

doi:10.16016/j.2097-0927.202307020

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颅脑术后患者气管拔管期安全性的影响因素分析

临床医学 | 更新时间：2026-01-09

- 颅脑术后患者气管拔管期安全性的影响因素分析
- Influencing factors for safety during endotracheal extubation after craniotomy
- 陆军军医大学学报 2023年45卷第19期页码：2074-2080
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：神经外科
  2.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：航空医学教研室
- 作者简介：
  
  [ 鲜继淑, E-mail: 1370321419@qq.com XIAN Jishu, E-mail: 1370321419@qq.com
- 基金信息：
  
  重庆英才青年拔尖人才项目(414ZD46)
- DOI：10.16016/j.2097-0927.202307020
  中图分类号： R181.32;R473.6;R651.11
- 收稿：2023-07-04，
  
  修回：2023-08-17，
  
  纸质出版：2023-10-15
- 稿件说明：
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汪睿, 李卫娜, 张超, 等. 颅脑术后患者气管拔管期安全性的影响因素分析[J]. 陆军军医大学学报, 2023,45(19):2074-2080.

Rui WANG, Weina LI, Chao ZHANG, et al. Influencing factors for safety during endotracheal extubation after craniotomy[J]. Journal of Army Medical University, 2023, 45(19): 2074-2080.
汪睿, 李卫娜, 张超, 等. 颅脑术后患者气管拔管期安全性的影响因素分析[J]. 陆军军医大学学报, 2023,45(19):2074-2080. DOI： 10.16016/j.2097-0927.202307020.

Rui WANG, Weina LI, Chao ZHANG, et al. Influencing factors for safety during endotracheal extubation after craniotomy[J]. Journal of Army Medical University, 2023, 45(19): 2074-2080. DOI： 10.16016/j.2097-0927.202307020.

摘要

目的

探讨神经外科颅脑术后患者气管拔管期安全性现状及拔管相关危险因素。

方法

采用前瞻性队列研究，纳入2022年2-10月在本院神经外科经颅脑术后气管插管的60例患者。其中男性19例(31.7%)，女性41例(68.3%)，年龄为18~75(47.2±15.7)岁。以拔管期血流动力学和呼吸氧合指标是否安全为结局指标，收集围术期、拔管期相关临床资料。采用单因素和多因素Logistic回归分析筛选出拔管期安全性的影响因素。

结果

共纳入60例患者，拔管不安全发生率36.7%。单因素二元Logistic回归分析结果示拔管期安全性的影响因素有：体质量指数(

=1.12，95%

：0.96~1.31)、吸烟史(

=5.29，95%

：0.93~30.11)、拔管前镇静镇痛(

=2.47，95%

：0.76~8.10)、苏醒方式(

=3.22，95%

：1.05~9.89)、拔管舒适性(

=4.09，95%

：1.31~12.81)、置管时长(＜24 h)(

=4.68，95%

：1.43~15.32，

0.2)。多因素二元Logistic回归分析发现自主苏醒(

=10.91，95%

：2.05~58.04)、拔管不舒适(

=6.68，95%

：1.42~31.48)、置管时长＜24 h(

=4.65，95%

：1.07~20.17)是影响拔管期安全性的独立危险因素(

0.05)。

结论

颅脑术后患者气管拔管不安全风险较高，苏醒方式、拔管舒适性及置管时长可能影响患者拔管的安全性。

Abstract

Objective

To investigate the current status and risk factors of endotracheal extubation safety after craniotomy.

Methods

A prospective cohort trial was carried out on 60 patients with endotracheal intubation after craniotomy in the neurosurgical department of our hospital from February to October 2022. There were 19 males (31.7%) and 41 females (68.3%)

at an age from 18 to 75 (47.2±15.7) years. The primary outcome was extubation safety based on hemodynamic and respiratory parameters. The clinical data during perioperative and extubation periods were collected. Univariate and multivariate logistic regression analyses were used to screen out the influencing factors for extubation safety.

Results

Among the 60 subjected patients

the incidence of unsafe extubation was 36.7% (22 cases). Univariate analysis using binary logistic regression showed that the factors affecting the safety of extubation were BMI (

=1.12

95%

: 0.96~1.31)

smoking history (

=5.29

95%

: 0.93~30.11)

sedation and analgesia before extubation (

=2.47

95%

: 0.76~8.10)

Methods of waking up from anesthesia (

=3.22

95%

: 1.05~9.89)

comfort of extubation (

=4.09

95%

: 1.31~12.81)

and duration of intubation (

=4.68

95%

: 1.43~15.32). Multivariate logistic regression analysis found that the independent risk factors for the safety included spontaneous awakening (

=10.91

95%

: 2.05~58.04)

uncomfortable extubation (

=6.68

95%

: 1.42~31.48) and duration of intubation

24 h (

=4.65

95%

: 1.07~20.17).

Conclusion

The endotracheal extubation after craniotomy is at high risk of unsafety. Methods of waking up from anesthesia

comfort during extubation

and duration of intubation may influence the safety of extubation.

关键词

Keywords

references

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