第四脑室肿瘤患儿术后拔管失败的危险因素及结局：一项病例对照研究
Risk factors and outcomes of postoperative extubation failure in children with fourth ventricular tumors: a case control study.
作者信息
Yang Wenmin, Huang Jinda, Chen Feiyan, Zhang Chunmin, Yang Yiyu
机构信息
Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center (Guangzhou Medical University), Guangzhou, Guangdong, 510030, China.
Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Renmin Middle Road 318, Yuexiu District, Guangzhou, Guangdong, China.
出版信息
BMC Pediatr. 2024 Dec 23;24(1):833. doi: 10.1186/s12887-024-05320-x.
BACKGROUND AND OBJECTIVE
Microsurgical resection of tumor is an important treatment for children with fourth ventricular tumors. There is a lack of data describing risk factors for postoperative extubation failure (EF) in these children. We aimed to identify risk factors for EF in children with fourth ventricular tumors and to determine the association between EF and clinical outcomes.
METHODS
A retrospective study review of children after fourth ventricular tumors surgery who had an extubation attempt between January 2020 to December 2023. Extubation failure was defined as re-intubation within 7 days of extubation. Multivariate logistic regression analysis was performed to explore the risk factors for EF. Bivariate statistical analysis was performed to determine associations between EF and clinical outcomes. Only the first extubation attempt was included in the analysis.
RESULTS
We included 103 children, of whom 10 (9.7%) experienced EF. In the logistic regression analysis, a weak/absent cough reflex was independently associated with EF (p < 0.001). Compared to those with a fair/ strong cough, patients with a weak/absent cough had a odds ratio (OR) of 41.25 for EF (95% CI,8.01-212.37; p < 0.001).Glasgow Coma Score(GCS), the obvious adhesion between the tumor and the fourth ventricle floor, and pulmonary variables were not associated with EF. Children who failed extubation had longer durations of mechanical ventilation [13 days (IQR 6.8-22.8) vs. 1 days (IQR 0.5-3), p < 0.001]; longer PICU lengths of stay [16.5 days (IQR 9.4-27.5) vs. 2 days (IQR1.5-4.3), p < 0.001] and longer hospital lengths of stay [27 days (IQR 21-31.8) vs. 20 days (IQR16-29), p = 0.05] than successfully extubated children.
CONCLUSIONS
Children with weak/absent cough reflex after surgery are at increased risk for extubation failure. Extubation failure is associated with significant adverse outcomes in our setting.
背景与目的
显微手术切除肿瘤是治疗儿童第四脑室肿瘤的重要方法。目前缺乏关于这些儿童术后拔管失败（EF）危险因素的数据。我们旨在确定儿童第四脑室肿瘤术后拔管失败的危险因素，并确定拔管失败与临床结局之间的关联。
方法
对2020年1月至2023年12月期间接受第四脑室肿瘤手术后尝试拔管的儿童进行回顾性研究。拔管失败定义为拔管后7天内再次插管。采用多因素逻辑回归分析探讨拔管失败的危险因素。进行双变量统计分析以确定拔管失败与临床结局之间的关联。分析仅纳入首次拔管尝试。
结果
我们纳入了103名儿童，其中10名（9.7%）发生拔管失败。在逻辑回归分析中，咳嗽反射微弱/消失与拔管失败独立相关（p<0.001）。与咳嗽反射良好/强烈的儿童相比，咳嗽反射微弱/消失的儿童发生拔管失败的比值比（OR）为41.25（95%CI，8.01-212.37；p<0.001）。格拉斯哥昏迷评分（GCS）、肿瘤与第四脑室底明显粘连以及肺部变量与拔管失败无关。拔管失败的儿童机械通气时间更长[13天（IQR 6.8-22.8）vs.1天（IQR 0.5-3），p<0.001]；儿科重症监护病房（PICU）住院时间更长[16.5天（IQR 9.4-27.5）vs.2天（IQR1.5-4.3），p<0.001]，住院时间也比成功拔管的儿童更长[27天（IQR 21-31.8）vs.20天（IQR16-29），p=0.05]。
结论
术后咳嗽反射微弱/消失的儿童拔管失败风险增加。在我们的研究中，拔管失败与显著的不良结局相关。
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