老年食管癌术后气管插管患者声门下分泌物滞留的影响因素

Influencing factors for subglottic secretion retention in elderly patients with tracheal intubation after surgery for esophageal cancer

【摘要】目的 对老年食管癌术后气管插管患者发生声门下分泌物滞留现状进行评估,并分析其影响因素。方法 回顾性分析南京医科大学附属淮安第一医院心胸外科于2022年4月至2023年12月收治的120例食管癌手术并气管插管患者的临床资料,以发生声门下分泌物滞留与否分为两组,其中滞留组患者75例,非滞留组患者45例。分析两组一般资料及围术期资料,采用logistic回归分析中的逐步回归法分析评估影响老年食管癌术后气管插管患者声门下分泌物滞留等的相关因素。采用SPSS 27.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。结果 滞留组年龄、有吸烟史人数均高于非滞留组,且该组患者手术时长、气管插管时间均多于非滞留组,留置胃管人数、喉返神经损伤人数及胃食管反流人数均高于非滞留组,差异均有统计学意义(P＜0.05)。回归分析结果显示,高龄(OR=2.380,95%CI1.076~5.264)、吸烟史(OR=2.323,95%CI 1.040~5.189)、术前留置胃管(OR=3.040,95%CI 1.543~5.990)、胃食管反流(OR=2.732,95%CI 1.247~5.983)是老年食管癌术后气管插管患者出现声门下分泌物滞留的独立风险因素(P＜0.05)。结论 老年食管癌术后患者在气管插管后存在声门下分泌物滞留风险,吸烟、高龄及消化系统疾病均是高危因素,临床应综合评估后对高风险人群应及时采取干预措施。

基金项目:江苏省老年健康科研项目(LKZ2022018)；江苏省卫生健康委医学科研面上项目(H201991)

【Abstract】Objective To evaluate the status of subglottic secretion retention in elderly patients with tracheal intubation following esophageal cancer surgery and analyze its influencing factors. Methods A retrospective study was conducted on 120 patients with endotracheal intubation undergoing surgery for esophageal cancer in our department from April 2022 to December 2023. According to having subglottic secretion retention or not, they were divided into a retention group (75 patients) and a non-retention group (45 patients). The general information and perioperative data were collected to analyze the relative factors with logistic stepwise regression analysis. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results The retention group had significantly advanced age, larger ratio of smoking history, longer operation time and duration of tracheal intubation, more patients having gastric tube indwelling, and larger numbers of experiencing recurrent laryngeal nerve injury and gastroesophageal reflux when compared with the non-retention group (P<0.05). Regression analysis showed that advanced age (OR=2.380,95%CI 1.076-5.264), smoking history (OR=2.323,95%CI 1.040-5.189), preoperative indwelling gastric tube (OR=3.040,95%CI 1.543-5.990), and gastroesophageal reflux (OR=2.732,95%CI 1.247-5.983) were independent risk factors for subglottic secretion retention in the elderly patients with endotracheal intubation (P<0.05). Conclusion For the elderly patients with tracheal intubation after surgery for esophageal cancer, they are at a risk of subglottic secretion retention. Smoking, advanced age and digestive diseases are high-risk factors. Thus, timely intervention measures should be taken for the high-risk patients after comprehensive clinical evaluation.

This work was supported by the Project of Senile Health Scientific Research of Jiangsu Province (LKZ2022018) and the General Project ofMedical Scientific Research of Jiangsu Provincial Health Commission (H201991).