Gurajala Indira, Ramachandran Gopinath, Iyengar Raju, Durga Padmaja
Department of Anaesthesiology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
Indian J Anaesth. 2013 Jan;57(1):14-8. doi: 10.4103/0019-5049.108554.
Patients undergoing corrective surgery for scoliosis of spine are commonly ventilated in our institute after the operation. Postoperative mechanical ventilation (PMV) and subsequent prolongation of intensive care unit stay are associated with increase in medical expenditure and complications such as ventilator-associated pneumonia. Identification of factors which may contribute to PMV and their modification may help in allocation of resources effectively. The present study was performed to identify preoperative and intraoperative factors associated with early PMV after scoliosis surgery.
One hundred and two consecutive patients who underwent operation for scoliosis correction between January 2006 to July 2011 were reviewed retrospectively. Patients requiring PMV included patients who were not extubated in the operating room and were continued on mechanical ventilation. Preoperative and intraoperative factors which were analysed included age, gender, weight, cardiorespiratory function, presence of kyphosis, number and level of vertebrae involved, surgical approach, whether thoracoplasty was done, duration of surgery, blood loss, fluids and blood transfused, hypothermia and use of antifibrinolytics.
The average age of the patients was 14.31±3.78 years with female preponderance (57.8%). Univariate analysis found that longer fusions of vertebrae (more than 8), blood loss, amount of crystalloids infused, blood transfused and hypothermia were significantly associated with PMV (P<0.05). Independent risk factors for PMV were longer fusion (Odds Ratio (OR), 1.290; 95% confidence interval (CI), 1.038-1.604) and hypothermia (OR, 0.096; 95% CI, 0.036-0.254; P<0.05).
The authors identified that longer fusions and hypothermia were independent risk factors for early PMV. Implementation of measures to prevent hypothermia may result in decrease in PMV.
在我们研究所，接受脊柱侧弯矫正手术的患者术后通常需要通气。术后机械通气（PMV）以及随后重症监护病房住院时间的延长与医疗费用增加和诸如呼吸机相关性肺炎等并发症相关。识别可能导致PMV的因素并对其进行调整可能有助于有效分配资源。本研究旨在识别脊柱侧弯手术后早期PMV相关的术前和术中因素。
回顾性分析2006年1月至2011年7月期间连续接受脊柱侧弯矫正手术的102例患者。需要PMV的患者包括在手术室未拔管并继续进行机械通气的患者。分析的术前和术中因素包括年龄、性别、体重、心肺功能、驼背的存在、受累椎体的数量和节段、手术入路、是否进行胸廓成形术、手术持续时间、失血量、液体和输血情况、体温过低以及抗纤溶药物的使用。
患者的平均年龄为14.31±3.78岁，女性占优势（57.8%）。单因素分析发现，椎体融合时间较长（超过8个）、失血量、晶体液输注量、输血量和体温过低与PMV显著相关（P<0.05）。PMV的独立危险因素是融合时间较长（比值比（OR），1.290；95%置信区间（CI），1.038 - 1.604）和体温过低（OR，0.096；95%CI，0.036 - 0.254；P<0.05）。
作者确定融合时间较长和体温过低是早期PMV的独立危险因素。采取预防体温过低的措施可能会减少PMV。
