【摘要】 目的探讨气囊漏气试验联合呼吸训练器试验在评估口腔癌术后延迟拔除气管插管患者拔管时机中的作用,分析再次气管插管的危险因素及预后。方法收集口腔癌术后延迟拔除气管插管转入重症监护室(ICU)的患者,依据其在拔管前是否进行气囊漏气试验及应用简易呼吸训练器评估分为试验组(226例)和对照组(242例)。结果试验组自主呼吸试验次数为(1.50±0.53)次,对照组为(1.40±0.82)次,差异无统计学意义(t=1.577,P=0.116)。试验组肺部感染发生率为5.31%、再次气管插管率为1.77%、气管切开率为0.88%、ICU入住时间为(4.10±1.35)d、死亡率为0.44%,均低于对照组的15.70%、10.74%、9.50%、(7.42±5.31)d、3.31%,差异均有统计学意义(χ~2=13.223,P<0.001;χ~2=15.687,P<0.001;χ~2=17.170,P<0.001;t=9.406,P<0.001;χ~2=5.080,P=0.024)。气囊漏气试验联合呼吸训练器试验在评估试验组口腔癌术后延迟拔除气管插管患者拔管时机中的敏感性和特异性分别为99.54%、62.50%。手术时间≥5 h、出血、大块皮瓣重建、气道周围水肿、术前行放疗导致周围局部解剖学变化或纤维化、肺部误吸是再次气管插管的危险因素(χ~2=166.992,P<0.001;χ~2=50.074,P<0.001;χ~2=75.447,P<0.001;χ~2=115.354,P<0.001;χ~2=22.127,P<0.001;χ~2=24.193,P<0.001)。再次气管插管组机械通气时间为(44.09±27.10)h、ICU入住时间为(11.59±5.60)d、死亡率为20.00%,均显著高于未再次气管插管组的(5.22±1.32)h、(5.00±1.73)d、0.68%,差异均有统计学意义(t=7.855,P<0.001;t=6.425,P<0.001;χ~2=55.537,P<0.001)。结论对于口腔癌术后延迟拔管患者,可采用气囊漏气试验及呼吸训练器试验评估患者气道梗阻情况及呼吸肌力量,准确掌握拔管时机。治疗过程中应当重视再次气管插管高风险患者,降低再次气管插管的风险,减少相关并发症发生,改善患者预后。更多还原

【Abstract】 Objective To explore the role of air bag leak test combined with breathing training device test in the patients with delayed tracheal intubation after oral cancer surgery, and to evaluate the risk factors and prognosis of re-tracheal intubation. Methods The patients with oral cancer who were delayed in the endotracheal intubation and were transferred to intensive care unit(ICU) were divided into the experimental group(226 patients) and the control group(242 patients) according to air bag leak test combined with breathing training device test.Results The spontaneous breath test frequency was 1.50±0.53 in the experimental group, and was 1.40±0.82 in the control group, there was no statistical difference between the two groups(t=1.577,P=0.116). The pulmonary infection incidence, re-intubation incidence, tracheotomy incidence, ICU stay time and mortality incidence were 5.31%, 1.77%, 0.88%,(4.10±1.35)d, 0.44% in the experimental group; and were 15.70%, 10.74%, 9.50%,(7.42±5.31)d, 3.31% in the control group(χ~2=13.223,P<0.001;χ~2=15.687,P<0.001;χ~2=17.170,P<0.001;t=9.406,P<0.001;χ~2=5.080,P=0.024),there were statistical difference between the two groups. For the patients with delayed extubation after oral cancer surgery, the sensitivity and specificity of air bag leak test combined with breathing training device test were 99.54% and 62.50%. The operation time ≥5 hours, bleeding, large flap reconstruction, peri-airway edema, preoperative radiotherapy and lung aspiration were the risk factors for re-intubation(χ~2=166.992,P<0.001;χ~2=50.074,P<0.001;χ~2=75.447,P<0.001;χ~2=115.354,P<0.001;χ~2=22.127,P<0.001;χ~2=24.193,P<0.001). The mechanical ventilation time[(44.09±27.10)h], ICU stay time[(11.59±5.60)d] and mortality incidence(20.00%) in the re-intubation group were significantly higher than those [(5.22±1.32)h,(5.00±1.73)d, 0.68%] in the without re-intubation group(t=7.855,P<0.001;t=6.425,P<0.001;χ~2=55.537,P<0.001). Conclusion For patients with delayed extubation after oral cancer surgery, air bag leak test combined with breathing training device test can be used to evaluate the timing of extubation. We should pay attention to re-intubation high-risk patients, reduce the re-intubation probability, reduce the occurrence of related complications and improve the prognosis.更多还原