Cai Ye-Hua, Zeng Heng-Yu, Shi Zhong-Hua, Shen Jing, Lei Yan-Ni, Chen Bi-Yao, Zhou Jian-Xin
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Int Med Res. 2013 Feb;41(1):208-17. doi: 10.1177/0300060513475964. Epub 2013 Jan 23.
To investigate prospectively the rate of, and factors influencing, delayed extubation following infratentorial craniotomy in a Chinese neurosurgical centre.
Patients undergoing infratentorial craniotomy for tumour resection were prospectively enrolled and stratified according to whether extubation was attempted in the operating theatre (early extubation) or not (delayed extubation). Pre- and intraoperative variables were collected and analysed. Multiple logistic regression analysis was performed, to identify factors related to delayed extubation.
The study included 800 patients, 398 (49.8%) of whom underwent delayed extubation. The overall rate of extubation failure was 3.6%. Independent factors related to delayed extubation were: preoperative lower cranial nerve dysfunction; hydrocephalus; tumour location; duration of surgery ≥ 6 h; estimated blood loss ≥ 1000 ml. Compared with patients in the early extubation group, those in the delayed extubation group had a higher rate of pneumonia, longer intensive care unit and postoperative hospital stays, and higher hospitalization costs.
Brain stem and lower cranial nerve function were the main factors affecting extubation decision-making. Further research is required, to establish criteria for delayed extubation following infratentorial craniotomy.
前瞻性研究中国一家神经外科中心幕下开颅术后延迟拔管的发生率及影响因素。
前瞻性纳入接受幕下开颅肿瘤切除术的患者，并根据是否在手术室尝试拔管（早期拔管）或未尝试拔管（延迟拔管）进行分层。收集并分析术前和术中变量。进行多因素逻辑回归分析，以确定与延迟拔管相关的因素。
该研究纳入800例患者，其中398例（49.8%）接受了延迟拔管。总体拔管失败率为3.6%。与延迟拔管相关的独立因素为：术前颅神经功能障碍；脑积水；肿瘤位置；手术时间≥6小时；估计失血量≥1000毫升。与早期拔管组患者相比，延迟拔管组患者的肺炎发生率更高，重症监护病房和术后住院时间更长，住院费用更高。
脑干和颅神经功能是影响拔管决策的主要因素。需要进一步研究以建立幕下开颅术后延迟拔管的标准。
