Arom K V, Emery R W, Petersen R J, Schwartz M
Minneapolis Heart Institute, Minnesota, USA.
Ann Thorac Surg. 1995 Jul;60(1):127-32.
This study examined predictors and cost-effectiveness of early extubation after coronary artery bypass grafting.
Six hundred forty-five patients admitted to intensive care units after coronary artery bypass grafting at our institutions in 1993 were reviewed. There were 455 male and 190 female patients, which included all patients in DRG 106 and DRG 107. The patients were categorized into three groups: group A (269 patients) were extubated in less than 12 hours (7.55 +/- 2.5 hours), group B (291 patients) were extubated between 12 and 24 hours (16.85 +/- 3.3 hours), and group C (376 patients) were extubated any time after 12 hours.
The reintubation rate for the entire group was less than 1%. Univariate preoperative analyses revealed small differences between groups A and B: only 6 of 25 variables were found to reach statistical significance. Stepwise logistic regression analyses were carried out in 269 patients of group A and 376 patients of group C. Older patients (log of age, p = 0.0001), female sex (p = 0.0129; odds ratio = 1.634), use of preoperative diuretics (p = 0.0010; odds ratio = 1.965) and unstable angina (p = 0.0301; odds ratio = 1.544) were noted to be clinical factors associated with late extubation (> or = 12 hours). Early extubation was accomplished in 42%; however, further analysis revealed that many patients who were intubated overnight should have been extubated sooner.
Early extubation shortened the postoperative length of stay, resulting in reduction of cost and resource utilization. The average hospital charge per patient was approximately $6,000 less in the early extubation group.
本研究探讨冠状动脉搭桥术后早期拔管的预测因素及成本效益。
回顾了1993年在我们机构接受冠状动脉搭桥术后入住重症监护病房的645例患者。其中男性455例，女性190例，包括DRG 106和DRG 107中的所有患者。患者分为三组：A组（269例）在12小时内拔管（7.55±2.5小时），B组（291例）在12至24小时之间拔管（16.85±3.3小时），C组（376例）在12小时后任何时间拔管。
整个组的再插管率低于1%。术前单因素分析显示A组和B组之间差异较小：25个变量中只有6个达到统计学意义。对A组的269例患者和C组的376例患者进行了逐步逻辑回归分析。发现老年患者（年龄对数，p = 0.0001）、女性（p = 0.0129；比值比 = 1.634）、术前使用利尿剂（p = 0.0010；比值比 = 1.965）和不稳定型心绞痛（p = 0.0301；比值比 = 1.544）是与延迟拔管（≥12小时）相关的临床因素。42%的患者实现了早期拔管；然而，进一步分析显示，许多过夜插管的患者本应更早拔管。
早期拔管缩短了术后住院时间，降低了成本和资源利用。早期拔管组每位患者的平均住院费用约少6000美元。
