摘要目的 筛选全麻患者术后再次气管插管的危险因素.方法 选择本院2010年1月至2012年12月麻醉后恢复室的全麻术后患者46 507例,年龄18～83岁,性别不限,将再次气管插管的患者作为再次气管插管组.按1∶5比例随机抽取同时期进入麻醉后恢复室无再次气管插管的患者,年龄18～83岁,作为对照组.记录患者一般资料、手术相关因素:手术类型(急诊/择期),手术部位(头颈部、气道、胸内、上腹部、下腹部、其他部位)和手术时间;麻醉相关因素:术毕前30 min内阿片类药物和肌松药物、术毕新斯的明的使用情况,将组间差异有统计学意义的因素进行logistic回归分析,筛选术后再次气管插管的危险因素.结果 32例患者术后再次气管插管,发生率为0.069％.2组患者年龄、性别、BMI、ASA分级、术前SpO2、合并术前2周内上呼吸道感染、慢性阻塞性肺疾病(COPD)、全身性炎症反应综合征(SIRS)和低蛋白血症、手术部位和手术时间比较差异有统计学意义(P ＜0.05或0.01).logistic回归分析结果显示:ASA分级≥Ⅲ级、合并COPD和SIRS、胸内手术是全麻患者术后再次气管插管的危险因素.结论 ASA分级≥Ⅲ级、合并COPD和SIRS、胸内手术是全麻患者术后再次气管插管的危险因素.

abstractsObjective To identify the risk factors for postoperative reintubation in patients undergoing general anesthesia.Methods Forty-six thousand five hundred and seven patients,aged 18-83 yr,requiring reintubation after planned extubation in the postanesthesia care unit (PACU) of our hospital from January 2010 to December 2012,served as reintubation group.Patients in a 1∶5 ratio,aged 18-83 yr,admitted to the PACU of our hospital from January 2010 to December 2012,with successful extubation,served as control group.The general data of patients and operation-related factors including type of operation (emergency operation/elective operation),operative sites (head and neck,airway,within the chest,upper abdomen,lower abdomen,other sites) and operation time and anesthesia-related factors including requirement for opioids and muscle relaxants within 30 min before operation,and for neostigmine at the end of operation were recorded.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify reintubation-related risk factors.Results Thirty-two patients were reintubated after operation and the incidence was 0.069％.There was significant difference in age,gender,body mass index,ASA physical status,preoperative SpO2,complication with upper respiratory infections within 2 weeks before operation,chronic obstructive pulmonary disease (COPD),or systemic inflammatory response syndrome (SIRS) and hypoproteinemia,operative sites and operation time between the two groups (P ＜ 0.05 or 0.01).The logistic regression analysis showed that ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery were closely correlated with postoperative reintubation in patients undergoing general anesthesia.Conclusion ASA physical status ≥ Ⅲ,complication with COPD or SIRS,and thoracic surgery are risk factors for postoperative reintubation in patients undergoing general anesthesia.