颅内术后延迟拔管患者顺利拔管影响因素分析：一项双向性队列研究




贵州医科大学          麻醉与心脏电生理课题组

翻译：赵游霄    编辑：赵游霄        审校：曹莹  

01
背景

  延迟拔管在颅内手术后较为常见，并与不良反应相关，这些反应会损害患者的安全与舒适度。因此，识别影响顺利拔管的因素至关重要，但现有证据有限。本研究旨在探讨颅脑手术患者拔管不良结局的风险因素，以提升拔管安全性与患者舒适度。

02
方法

  于2022年5月至2023年9月在一所大学医院进行了一项双向性队列研究，共纳入157名颅内术后延迟拔管的患者。收集的临床数据包括人口统计学特征、神经系统状态、呼吸参数、术中及麻醉管理情况以及术后因素。顺利拔管定义为拔管时血压呼吸稳定、无疼痛或躁动。采用多因素Logistic回归分析确定影响不良拔管的独立因素。


03
结果

    在157名患者中（平均BMI 23.88 ± 3.25 kg/m²，男性占33.1%），有80人（51.0%）发生了不良拔管。单因素分析显示多个变量具有显著性（P < 0.05）：年龄、FOURE评分、FOURM评分、气道通畅度、从遵嘱到拔管的时长、拔管时机、手术类型、手术时长、术中丙泊酚使用、拔管前镇静。多因素分析显示：年龄[OR = 2.791, 95%CI (1.268, 6.147)]、术中丙泊酚使用[OR = 0.298, 95%CI (0.012, 0.796)]、术前气道通畅度[OR = 2.463, 95%CI (1.159, 5.234)]、拔管时机[OR = 7.884, 95%CI (1.337, 46.472)] 是不良拔管的独立影响因素。







【罂粟摘要】颅内术后延迟拔管患者顺利拔管影响因素分析：一项双向性队列研究









   在腹腔手术后，采用位于外侧弓状韧带上方的前侧腰方肌阻滞，能显著减少术后 24 小时内的阿片类药物用量，延长首次患者自控镇痛启动的时间，并降低术后恶心呕吐的发生率

原始文献：

Wang R, Liu Y, Li W, Zhang C, Zhang X, Wang F, Li Y, Yang X, Tan B, Chen T, Xian J. Analysis of factors affecting smooth extubation in delayed extubation patients following intracranial surgery: an ambispective cohort study. BMC Anesthesiol. 2025 Oct 29;25(1):531. doi: 10.1186/s12871-025-03394-3. PMID: 41163173; PMCID: PMC12573943..

英文原文：

Analysis of factors affecting smooth extubation in delayed extubation patients following intracranial surgery: an ambispective cohort study

Abstract 

Objective: Delayed extubation is common after intracranial surgery, and is associated with adverse reactions that compromise patient safety and comfort. Identifying factors that influence smooth extubation is therefore critical, but available evidence is limited. This study aims to explore risk factors of extubation adverse outcomes in patients undergoing craniocerebral surgery, with the goal of enhancing extubation safety and patient comfort.

Methods: An ambispective cohort study was conducted at a university hospital from May 2022 to September 2023, involving 157 patients with delayed extubation post-intracranial surgery. Clinical data encompassing demographic characteristics, neurological status, respiratory parameters, intraoperative and anesthetic management, and postoperative factors. Smooth extubation was defined as extubation with stable blood pressure, respiratory function, and absence of pain or agitation. Multivariate logistic regression identified independent factors influencing adverse extubation.

Results: Of 157 patients (mean BMI 23.88 ± 3.25 kg/m2, 33.1% male), adverse extubation occurred in 80 (51.0%). Univariate analysis showed several significant variables (P < 0.05): age, FOURE, FOURM, airway patency, Duration from command obedience to extubation, time to extubate, types of surgical procedure, operation duration, intraoperative propofol use, sedation before. Multivariate analysis showed: age [OR = 2.791, 95%CI (1.268, 6.147)], intraoperative propofol use [OR = 0.298, 95%CI (0.012, 0.796)], preoperative airway patency [OR = 2.463, 95%CI (1.159, 5.234)], time to extubate [OR = 7.884, 95%CI (1.337, 46.472)] as independent factors of dverse extubation.

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