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| 病态肥胖患者胃减容术后延迟拔管的危险因素分析 |
| Analysis of risk factors for delayed extubation after laparoscopic bariatric surgery in morbidly obese patients |
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| DOI：10.12089/jca.2022.08.011 |
| 中文关键词: 病态肥胖 早期拔管 睡眠呼吸暂停综合征 危险因素 |
| 英文关键词: Morbid obesity Early extubation Obstructive sleep apnea syndrome Risk factor |
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| 中文摘要: |
目的 分析病态肥胖患者胃减容术后延迟拔管的危险因素。
方法 检索医院病案系统，回顾性收集2012年9月至2018年12月在全麻下行腹腔镜下胃减容术的369例病态肥胖患者的手术麻醉相关资料，男139例，女230例，年龄18~60岁，BMI>35 kg/m2。根据拔管地点的不同将患者分为两组：非延迟拔管组（手术室拔管，ND组）和延迟拔管组（非手术室拔管，D组）。比较两组人口学资料、吸烟史、术前合并症、术中麻醉药物用量、出入量、手术时间、麻醉时间、总住院时间和术后住院时间等，采用多因素Logistic回归分析术后延迟拔管的危险因素。
结果 延迟拔管的患者有109例（29.5%）。D组男性比例、体重、理想体重、BMI、吸烟史比例、合并高血压、糖尿病、冠状动脉粥样硬化、阻塞性睡眠呼吸暂停综合征（OSA）比例、睡眠呼吸紊乱指数（AHI）明显高于ND组，年龄明显大于ND组，呼吸暂停时间明显长于ND组（P<0.05）。多因素Logistic回归分析结果显示，体重增加（OR=1.045，95%CI 1.004～1.087，P<0.05），BMI增大（OR=2.020，95%CI 1.185～3.442，P<0.05）、合并高血压（OR=3.284，95%CI 1.379～7.824，P<0.05）和AHI升高（OR=1.072，95%CI 1.052～1.093，P<0.001）是术后延迟拔管的独立危险因素。
结论 病态肥胖患者体重增加、BMI增大、合并高血压和AHI升高是术后延迟拔管的独立危险因素。 |
| 英文摘要: |
Objective To evaluate the possible risk factors of delayed extubation after laparoscopic bariatric surgery in morbidly obese patients.
Methods Patients who received laparoscopic bariatric surgery under general anesthesia from September 2012 to December 2018 were enrolled, involving 139 males and 230 females, aged 18-60 years, BMI > 35 kg/m2. By retrieving the medical record system, information related to surgery and anesthesia were collected. The patients were divided into two groups according to different extubation time after surgery: non-delayed extubation group (extubation in operating room, group ND) and delayed extubation group (extubation not in operating room, group D). The demographic data, history of smoking, preoperative complications, dose of anesthetics, intake and output volume, surgical time, anesthesia time, length of hospital stay and postoperative hospital stay were analyzed. Multiple Logistic regression model was used to analyze the risk factors of delayed extubation after surgery.
Results There were 109 patients (29.5%) with delayed extubation. The proportion of male, weight, ideal body weight, BMI, smoking history, hypertension, diabetes, coronary atherosclerosis, obstructive sleep opnea syndrome (OSA), and sleep apnea index (AHI) in group D were significantly higher than those in group ND, and the age was significantly higher than that in group ND, and the duration of apnea was significantly longer than that in group ND (P < 0.05). Multivariate Logistic regression analysis showed that weight (OR = 1.045, 95% CI 1.004-1.087, P < 0.05), BMI (OR = 2.020, 95% CI 1.185-3.442, P < 0.05), hypertension (OR = 3.284, 95% CI 1.379-7.824, P < 0.05) and AHI (OR = 1.072, 95% CI 1.052-1.093, P < 0.001) were independent risk factors for delayed extubation after surgery.
Conclusion Morbid obesity patients with increased weight, increased BMI, hypertension and increased AHI are independent risk factors for delayed extubation after surgery. |
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