目的：探讨气管支架置入术后诱发痰液分泌增多、痰液潴留合并窒息的危险因素，并且分析其相关性。方法：通过回顾性分析的方法，收集本院2011年1月—2016年1月因中心气道狭窄或气管瘘行气管支架置入患者的临床资料，共110例，基于是否发生痰液潴留合并窒息分为两组，根据以往文献，筛选可能的危险因素，诸如性别、病因、支架类型、胸腔积液、肺内感染以及放疗史等，单因素分析使用卡方检验；多因素分析使用Logistics回归法，以确定危险因素，并且评价其与痰液潴留合并窒息的相关性。结果：18例（16.4%）患者均有痰液潴留合并窒息，最终死于呼吸、循环衰竭。在所有窒息的患者中，单因素分析提示：支架类型、胸腔积液、贫血及呼吸衰竭是独立的危险因素，而年龄、病因以及放疗史等因素的差别均无统计学意义。多因素分析提示术前Ⅱ型呼吸衰竭与术后窒息的发生显著相关。结论：术前Ⅱ型呼吸衰竭是导致气管支架置入术后患者出现痰液潴留并发窒息的显著危险因素。
Abstract
Objective: To investigate the risk factors of asphyxia caused by sputum retention and to analyze the correlation between the risk factors and the occurrence of asphyxia after stent implantation. Methods: A total of 110 patients with central airway obstruction or tracheal fistula who were encountered in author’s hospital during the period from Jan. 2011 to Jan. 2016 were enrolled in this study. Tracheal stent placement was performed in all patients. After the treatment, the patients were divided into two groups based on the occurrence of asphyxia caused by sputum retention. According to literatures, we choose risk factors such as gender, etiology, types of stents, infection and the history of radiotherapy. The data were compared between the two groups through the univariate factor and multivariate factor analysis to evaluate their correlations. Results: 18 cases(16.4%) showed sputum retention with asphyxia and died as a result of respiratory and circulatory failure. In all patients with asphyxia, univariate analysis suggests that stent type, pleural effusion, anemia and respiratory failure were the risk factors leading to asphyxia. Age, etiology, and the history of radiotherapy were not significantly different. Multivariate analysis showed that preoperative type Ⅱ respiratory failure was significantly related to the occurrence of postoperative asphyxia. Conclusion: The presence of preoperative type Ⅱ respiratory failure is a significant risk factor associated with asphyxia caused by sputum retention after tracheal stent implantation.
关键词
气管狭窄 /
窒息 /
支架
Key words
Tracheal stenosis /
Asphyxia /
Stents
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