下颌骨肿瘤术后预防性气管切开因素分析

doi:10.19439/j.sjos.2020.03.020

上海口腔医学 ›› 2020, Vol. 29 ›› Issue (3): 329-332.doi: 10.19439/j.sjos.2020.03.020

下颌骨肿瘤术后预防性气管切开因素分析

金立红^1,*, 顾振华^2,*, 陈志峰³, 徐辉³

1.上海交通大学医学院附属上海儿童医学中心麻醉科,儿童临床药理研究室,上海 200127;
2.上海浦东新区妇幼保健院,上海 201206;
3.上海交通大学医学院附属上海第九人民医院麻醉科,上海 200011

收稿日期:2019-04-24 修回日期:2019-07-10 出版日期:2020-06-25 发布日期:2020-07-29
通讯作者: 陈志峰,E-mail：282260759@qq.com.cn
作者简介:金立红（1987-）,女,硕士,主治医师,E-mail：1738089011@qq.com.cn;顾振华（1977-）,男,本科,主治医师,E-mail：15216836853@163.com。*并列第一作者
基金资助:
上海交通大学医学院附属上海儿童医学中心院基金 (YS-SCMC2017-2)

Factors affecting selection of tracheostomy after mandibular tumor operation: a retrospective study

JIN Li-hong¹, GU Zhen-hua², CHEN Zhi-feng³, XU Hui³

1. Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. Shanghai 200127;
2. Department of Anesthesiology,Maternity Hospital of Pudong New Area. Shanghai 201206;
3. Department of Anesthesiology & Intensive Care unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2019-04-24 Revised:2019-07-10 Online:2020-06-25 Published:2020-07-29

摘要/Abstract

摘要： 目的探讨下颌骨肿瘤患者行下颌骨部分切除术后需预防性气管切开的可能因素,为该类手术术后是否需要预防性气管切开提供依据。方法选择2008年1月—2012年12月于上海交通大学医学院附属第九人民医院进行下颌骨部分切除术的165例下颌骨肿瘤患者,术后带气管导管81例,术后预防性气管切开84例。记录患者的年龄、性别、体重、ASA分级、烟酒嗜好、肺部疾病史、下颌骨手术史、术前放疗史、手术时间、游离皮瓣修复情况、下颌骨切除是否过前正中线及颈淋巴清扫术情况。采用SAS 9.2软件包进行统计学分析,筛选出有意义的变量后,利用多因素Logist回归进一步分析需行气切的可能因素。结果气管切开组与气管插管组相比,2组患者的年龄、性别构成、ASA分级、烟酒嗜好、肺部疾病史及下颌骨手术史,差异均无统计学意义（P>0.05）。术前放疗史（OR: 3.51, 95%CI: 1.34~9.20）、游离皮瓣修复（OR: 3.99, 95%CI: 1.84~8.65）及下颌骨切除过中线（OR: 20.08, 95%CI: 6.52~160.35）3个因素差异有统计学意义。结论术前有放疗史、术中进行游离皮瓣修复和下颌骨切除范围超过前正中线的下颌骨肿瘤患者,行下颌骨部分切除术后需要考虑气管切开。

关键词: 下颌骨肿瘤, 气管切开, 下颌骨切除术

Abstract: PURPOSE: To assess the factors affecting selection of tracheostomy after mandibulectomy. METHODS: The clinical data of 165 patients who were divided into intubated group and tracheostomy group were collected from January 2008 to December 2012 in Shanghai Ninth People's Hospital, including demographics, smoke habits, alcohol consumption, pulmonary disease, American Society of Anesthesiologists (ASA) physical status classification, history of jaw operation, length of surgery, preoperative radiotherapy, free flap reconstruction, resection over the anterior midline, and radical neck dissection. The postoperative outcomes, such as the duration of keeping tube, the length of ICU stay, the length of hospital stay, and the number of complications and death were collected. Statistical analysis was performed using SAS version 9.2 software package. RESULTS: There were 81 patients in intubated group and 84 patients in tracheostomy group. Three factors that might be associated with selection of tracheostomy after mandibulectomy were preoperative radiotherapy (OR: 3.51, 95% CI: 1.34-9.20), free flap reconstruction (OR: 3.99, 95%CI: 1.84-8.65), and resection over the anterior midline of the jaw (OR: 20.08, 95%CI: 6.52-160.35)(P<0.05). CONCLUSIONS: Tracheostomy was suitable for patients who received preoperative radiotherapy, free flap reconstruction and resection over the anterior midline after mandibular tumor resection were factors in considering of tracheotomy.

Key words: Mandibular tumor, Tracheostomy, Mandibulectomy

中图分类号:

R782.05

金立红, 顾振华, 陈志峰, 徐辉. 下颌骨肿瘤术后预防性气管切开因素分析[J]. 上海口腔医学, 2020, 29(3): 329-332.

JIN Li-hong, GU Zhen-hua, CHEN Zhi-feng, XU Hui. Factors affecting selection of tracheostomy after mandibular tumor operation: a retrospective study[J]. Shanghai Journal of Stomatology, 2020, 29(3): 329-332.

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下颌骨肿瘤术后预防性气管切开因素分析

Factors affecting selection of tracheostomy after mandibular tumor operation: a retrospective study

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