【摘要】 目的 探讨后颅窝肿瘤患者计划性气管插管拔管失败的危险因素及预测效果。方法 选取2022年12月至2023年12月治疗的后颅窝肿瘤患者115例，按照患者气管插管拔管是否成功分为成功组94例，失败组21例。采用Logistic回归分析影响拔管结局的相关因素，根据结果构建风险预测模型，绘制受试者工作曲线(ROC)。结果 2组患者年龄、性别、合并基础疾病、BMI、浅快呼吸指数差异有统计学意义(P>0.05),吸烟、SOFA评分、GCS评分、机械通气时间差异有统计学意义(P<0.05),成功组膈肌活动度、膈肌增厚分数以及咳嗽咳痰能力明显高于失败组(P<0.05);Logistic回归分析结果表明，吸烟、机械通气时间、膈肌增厚分数是拔管结局的影响因素(P<0.05);根据多因素分析筛选所得的主要危险因素权重对其进行赋值，构建影响气管插管失败发生的列线图模型，机械通气时间得分为76分、膈肌增厚分数的得分为99分，吸烟得分为43分；ROC诊断结果表明，吸烟、机械通气时间、膈肌增厚分数对气管插管失败的诊断价值较高，ROC曲线下面积为0.883,表明预测模型的准确度较高。结论 吸烟、机械通气时间、膈肌增厚分数是后颅窝肿瘤患者气管插管拔管失败的影响因素，采用上述指标构建的风险预测模型能够有效评估患者的复发情况。更多还原

【Abstract】 Objective To investigate the risk factors for the failure of planned tracheal intubation and extubation in patients with posterior fossa tumors and prediction effects.Methods A total of 115 patients with posterior cranial fossa tumor treated from December 2022 to December 2023 were selected.Depending on the success or failure of tracheal intubation and extubation, patients were divided into the success group(n=94) and failure group(n=21).Logistic regression analyzed risk factors for the extubation outcomes, and a nomogram to predict the failure of planned tracheal intubation and extubation in patients with posterior fossa tumors was built.Receiver operating characteristic(ROC) curves were plotted to assess its performance.Results There were no significant difference in age, gender, admission diagnosis, combined underlying diseases, body mass index(BMI), smoking status, the Sequential Organ Failure Assessment(SOFA) score, the Glasgow Coma Scale(GCS) score, duration of mechanical ventilation, and the rapid shallow breathing index(RSBI) between the two groups(P>0.05).The diaphragm mobility, diaphragm thickening fraction, and coughing ability in the success group were significantly higher than the failure group(P<0.05).Logistic regression showed that smoking, duration of mechanical ventilation, and diaphragm thickening fraction significantly influenced the extubation outcomes(P<0.05).Risk factors obtained from the multivariate logistic regression were assigned according to the corresponding weights, and a nomogram was built, in which smoking, duration of mechanical ventilation, and diaphragm thickening fraction were assigned as 43, 76, and 99 points, respectively.ROC curve showed the high diagnostic potentials of smoking, duration of mechanical ventilation, and diaphragm thickening fraction in predicting the failure of extubation, with an area under the curve(AUC) of 0.883, indicating the high accuracy of the nomogram.Conclusion Smoking, duration of mechanical ventilation, and diaphragm thickening fraction are risk factors for the failure of planned tracheal intubation and extubation in patients with posterior fossa tumors.A nomogram built based on these risk factors effectively predicts the recurrence.更多还原