脑膜瘤切除术后不同拔管时机对术后肺炎的影响：一项回顾性队列研究。

Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study.

机构信息

Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China.

Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.

出版信息

BMC Anesthesiol. 2022 Sep 16;22(1):296. doi: 10.1186/s12871-022-01836-w.

DOI:10.1186/s12871-022-01836-w

PMID:36114451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9479244/

Abstract

BACKGROUND

This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection.

METHODS

We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21-35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias.

RESULTS

Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21-35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching.

CONCLUSIONS

Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room.

摘要

背景

本研究旨在探讨拔管时间及其与脑膜瘤切除术后肺炎（POP）的关系。

方法

我们研究了 2016 年 1 月至 2020 年 12 月期间 598 例接受脑膜瘤切除术的患者的拔管时间。将拔管时间作为分类变量进行分析，并将患者分为 21 分钟内、21-35 分钟和≥35 分钟组。我们的主要结局代表 POP 的发生率。使用多变量逻辑回归混合效应模型评估拔管时间与 POP 之间的关系，该模型调整了先前报道的混杂因素。还进行了倾向评分匹配（PSM），以 1:1 的比例进行，以尽量减少潜在的偏倚。

结果

在 598 例患者（平均年龄 56.1±10.7 岁，75.8%为女性）中，平均拔管时间为 32.4 分钟。术后分别在 21 分钟内（32.4%）、21-35 分钟（31.2%）和≥35 分钟（36.4%）完成拔管。年龄较大的患者（平均年龄 57.8 岁）在手术室中更倾向于延迟拔管（≥35 分钟），并且更倾向于围手术期补液。当拔管时间作为连续变量进行分析时，拔管时间与 POP 呈 U 型关系（非线性 P 值=0.044）。在调整混杂因素后，拔管时间≥35 分钟与 POP 相关（优势比[OR]，2.73；95%置信区间[CI]，1.36~5.47）。此外，匹配后的结果与匹配前的结果一致。