Butterworth J, James R, Prielipp R C, Cerese J, Livingston J, Burnett D A
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
Anesthesiology. 1998 Jun;88(6):1437-46. doi: 10.1097/00000542-199806000-00005.
The authors hypothesized that shorter-acting opioid and neuromuscular blocking drugs would be associated with reductions in duration of intubation, length of stay (LOS) in the intensive care unit (ICU) after tracheal extubation, or postoperative (exclusive of ICU) LOS, and that shorter durations of intubation would be associated with reduced ICU LOS after extubation and postoperative (exclusive of ICU) LOS.
One-thousand ninety-four patients undergoing primary coronary artery bypass graft surgery at 40 academic health centers were studied. Multiple patient-related factors were included in multivariate models for hypothesis testing.
The duration of tracheal intubation, ICU LOS after extubation, and postoperative (exclusive of ICU) LOS all varied significantly by site. There was no difference between vecuronium and pancuronium in duration of intubation, ICU LOS after extubation, or postoperative (exclusive of ICU) LOS. Use of sufentanil rather than fentanyl was associated with a significant (P=0.045) reduction of 1.9 h (95% CI, 0.04 to 4.1 h) in duration of tracheal intubation but had no significant effect on ICU LOS after extubation, total ICU LOS, postoperative (exclusive of ICU) LOS, or total postoperative LOS. The authors' best model predicts a complex association between increasing duration of intubation and both ICU LOS after tracheal extubation and postoperative (exclusive of ICU) LOS, which was associated with an increase in those measures when duration of intubation exceeded 7.3 or 3 h, respectively.
The LOS measures varied considerably among the institutions. Use of shorter-acting opioid and neuromuscular blocking drugs had no association with ICU LOS after tracheal extubation or with postoperative (exclusive of ICU) LOS. Only when the duration of intubation exceeded threshold values was it associated with increased LOS measures.
作者推测，作用时间较短的阿片类药物和神经肌肉阻滞剂与插管时间缩短、气管拔管后重症监护病房（ICU）住院时间（LOS）或术后（不包括ICU）LOS的缩短相关，且插管时间缩短与拔管后ICU LOS及术后（不包括ICU）LOS的缩短相关。
对40家学术医疗中心的1094例行初次冠状动脉搭桥手术的患者进行研究。多变量模型纳入了多个患者相关因素用于假设检验。
气管插管时间、拔管后ICU LOS及术后（不包括ICU）LOS在不同地点间差异显著。维库溴铵和泮库溴铵在插管时间、拔管后ICU LOS或术后（不包括ICU）LOS方面无差异。使用舒芬太尼而非芬太尼与气管插管时间显著缩短（P = 0.045）1.9小时（95%CI，0.04至4.1小时）相关，但对拔管后ICU LOS、总ICU LOS、术后（不包括ICU）LOS或总术后LOS无显著影响。作者的最佳模型预测，插管时间延长与气管拔管后ICU LOS及术后（不包括ICU）LOS之间存在复杂关联，当插管时间分别超过7.3小时或3小时时，这些指标会随之增加。
各机构间LOS指标差异很大。使用作用时间较短的阿片类药物和神经肌肉阻滞剂与气管拔管后ICU LOS或术后（不包括ICU）LOS无关。只有当插管时间超过阈值时，才与LOS指标增加相关。
