拔管后正压与常压技术下术后肺炎的风险：一项单中心回顾性观察研究
Risk of postoperative pneumonia after extubation with the positive pressure versus normal pressure technique: a single-center retrospective observational study.
作者信息
Shimada Kensuke, Gosho Masahiko, Ohigashi Tomohiro, Kume Keitaro, Yano Takahiro, Ishii Ryota, Maruo Kazushi, Inokuchi Ryota, Iwagami Masao, Ueda Hiroshi, Tanaka Makoto, Sanuki Masaru, Tamiya Nanako
机构信息
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
Department of Biostatistics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
出版信息
J Anesth. 2025 Feb;39(1):5-14. doi: 10.1007/s00540-024-03409-2. Epub 2024 Sep 12.
PURPOSE
A normal pressure extubation technique (no lung inflation before extubation), proposed by the Japanese Society of Anesthesiologists to prevent droplet infection during the coronavirus disease 2019 (COVID-19) pandemic, could theoretically increase postoperative pneumonia incidence compared with a positive pressure extubation technique (lung inflation before extubation). However, the normal pressure extubation technique has not been adequately evaluated. This study compared postoperative pneumonia incidence between positive and normal pressure extubation techniques using a dataset from the University of Tsukuba Hospital.
METHODS
In our hospital, the extubation methods changed from positive to normal pressure extubation techniques on March 3, 2020 due to the COVID-19 pandemic. Thus, we compared the risk of postoperative pneumonia between the positive (April 1, 2017 to December 31, 2019) and normal pressure extubation techniques (March 3, 2020 to March 31, 2022) using propensity score analyses. Postoperative pneumonia was defined using the International Classification of Diseases, 10th Edition (ICD-10) codes (J13-J18), and we reviewed the medical records of patients flagged with these ICD-10 codes (preoperative pneumonia and ICD-10 codes for prophylactic antibiotic prescriptions for pneumonia).
RESULTS
We identified 20,011 surgeries, including 11,920 in the positive pressure extubation group (mean age 48.2 years, standard deviation [SD] 25.2 years) and 8,091 in the normal pressure extubation group (mean age 47.8 years, SD 25.8 years). The postoperative pneumonia incidences were 0.19% (23/11,920) and 0.17% (14/8,091) in the positive and normal pressure extubation groups, respectively. The propensity score analysis using inverse probability weighting revealed no significant difference in postoperative pneumonia incidence between the two groups (adjusted odds ratio 0.98, 95% confidence interval 0.50 to 1.91, P = 0.94).
CONCLUSIONS
These results indicated no increased risk of postoperative pneumonia associated with the normal pressure extubation technique compared with the positive pressure extubation technique.
CLINICAL TRIAL NUMBER
Clinical trial number: UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364.
目的
日本麻醉医师协会提出的一种常压拔管技术（拔管前不进行肺充气），旨在预防2019冠状病毒病（COVID-19）大流行期间的飞沫感染，理论上与正压拔管技术（拔管前肺充气）相比，可能会增加术后肺炎的发生率。然而，常压拔管技术尚未得到充分评估。本研究使用筑波大学医院的数据集比较了正压和常压拔管技术术后肺炎的发生率。
方法
在我院，由于COVID-19大流行，2020年3月3日拔管方法从正压拔管技术改为常压拔管技术。因此，我们使用倾向评分分析比较了正压拔管技术组（2017年4月1日至2019年12月31日）和常压拔管技术组（2020年3月3日至2022年3月31日）术后肺炎的风险。术后肺炎根据国际疾病分类第10版（ICD-10）编码（J13-J18）进行定义，我们审查了标记有这些ICD-10编码的患者的病历（术前肺炎和肺炎预防性抗生素处方的ICD-10编码）。
结果
我们确定了20,011例手术，其中正压拔管组11,920例（平均年龄48.2岁，标准差[SD]25.2岁），常压拔管组8,091例（平均年龄47.8岁，SD 25.8岁）。正压和常压拔管组的术后肺炎发生率分别为0.19%（23/11,920）和0.17%（14/8,091）。使用逆概率加权的倾向评分分析显示，两组术后肺炎发生率无显著差异（调整后的优势比为0.98，95%置信区间为0.50至1.91，P = 0.94）。
结论
这些结果表明，与正压拔管技术相比，常压拔管技术不会增加术后肺炎的风险。
临床试验编号
临床试验编号：UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364
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