The Analysis Of Delayed Extubation After Thoracotomy Lobectomy Surgery For Lung Cancer Patients

Abstract Objective: To analysis of delayed extubation after thoracotomylobectomy surgery for lung cancer patients. To explore ways of shorting thepostoperative mechanical ventilation time of lung cancer patients and to reducethe occurrence of postoperative complications and hospitalization time.Method: A retrospective review of706lung cancer patients undergoinglung resection with general anesthesia at Tumor Hospital of Guangxi MedicalUniversity from October2008to October2013. There were455males and251females, at age range of22-82years, average55years,411cases in the leftlobectomyand295cases in the right lobectomy Patients’ general condition,preoperative examination, intraoperative, postoperative management and otherrelated factors were all recorded. Single factors analysis adopted t-test, chi-square test or rank-sum test. Unconditional Logistic regression modelanalysis (LR Method) to analyze the relationship between these indicators andthe incidence of extubation delay. It is divided into normal group and delayedextubation group according to whether with the delayed extubation or not. Theincidence of postoperative complications and hospitalization time were recordedin the two groups. Discuss the delayed extubation and postoperativecomplications、length of stay in the relationship. Select24cases of lung cancerpatients undergoing lobectomy during November2013-March2014, usingdouble-lumen endobronchial intubation anesthesia. It is divided into normal lungfunction group and abnormal lung function group according to the differentpreoperative pulmonary function.(Each group of12cases). two groups ofpostoperative extubation time, complication rate and hospitalization time wererecorded. Analysis of the relationship between preoperative pulmonary functionand postoperative extubation time, complications and hospitalization timeResult: There were51patients with postoperative extubation delay in706cases. The incidence was7.2%. In the delayed extubation group, the incidenceof complications was35.3%(18/51), the average days of hospital stay were17.5±6.2days. In the normal extubation group, the incidence of complicationswas15.6%(102/655), the average days of hospital stay were14.1±7.3days. Thelength of stay and complication rates in delayed extubation patients wereremarkable higher than normal patients with statistically significant difference (P<0.05). Single factors analysis showed7factors including: age, Smokingstatus, Preoperative complications, Body mass index, Single lung time,Preoperative albumin, Preoperative pulmonary function.Unconditional Logisticregression model showed that there are five independent risk factors resulted inthe delayed extubation: age>60years old (OR=6.568，P<0.001), single lungventilation for a long time (OR=1.268，P=0.047), male (OR=1.511，P=0.046),urine <=17ml/h (OR=1.456，P=0.032), abnormal lung function (OR=1.579，P=0.033). In the abnormal lung function group, the Postoperative extubationtime is （190±33）min, in the normal lung function group, the Postoperativeextubation time is(103.9±17) min. The postoperative intubation time of theabnormal lung function group was longer than the normal lung function group,with statistically significant difference (P<0.05). In the abnormal lung functiongroup, the incidence of complications was66.7%（8/12）, in the normal lungfunction group, the incidence of complications was16.7%(2/12), the incidenceof postoperative complications of the abnormal lung function group wassignificantly higher than the normal lung function group with statisticallysignificant difference (P<0.05). In the abnormal lung function group, theaverage days of hospital stay i（s29±5）d, in the normal lung function group, theaverage length of hospital stay is （23±2.3）d. the average days of hospital stayof the abnormal lung function group was remarkable longer than the normallung function group with statistically significant difference (P<0.05) Conclusion: Postoperative delayed extubation of lung cancer patientsundergoing lobectomy increases the days of hospital stay and postoperativecomplications. Postoperative extubation delay was caused by multi-factorsynergism, mainly related to Poor preoperative lung function, Elderly malepatients, Urine, Long single-lung ventilation and other relevant factors.Abnormal preoperative pulmonary function of patients had significantly longerpostoperative extubation time and days of hospital stay. And had a higherincidence of postoperative complications.