| ObjectiveTo investigate the effect of general anesthesia with laryngeal mask airway(LMA)and endotracheal intubation(ETT)on pulmonary infection after choledocholithotomy,,and to analyze the risk factors of postoperative pulmonary infection,so as to provide for the management of individualized anesthesia program.Methods A total of 1904 patients who underwent elective choledocholithotomy for choledocholithiasis in our hospital from January 1,2017 to December 31,2019 were collected.According to the different airway management tools of general anesthesia,the patients who met the criteria were divided into two groups: endotracheal intubation general anesthesia group(ETT group)and laryngeal mask airway general anesthesia group(LMA group).In this retrospective study,the researchers accurately recorded the demographic characteristics of patients and the information of hospitalization and surgical anesthesia after admission.In this study,univariate analyse was performed,followed by propensity score matching(PSM),and 403 cases of ETT and LMA patients with general anesthesia were obtained by 1:1 matching.After adjusting for confounding factors,the effects of LMA and ETT on pulmonary infection were analyzed in the same way.The risk factors of pulmonary infection were further analyzed by unconditional multivariate logical regression analysis.This study also conducted a series of subgroup analyses to further verify the association between LMA or ETT and postoperative pulmonary infection.Results1.1415 patients were selected in this study,including 990 patients in ETT group(70.0%),LMA group(30.0%),ASA grade Ⅰ～Ⅲ,with a median age of 64 years(interquartile range: 53-72 years).A total of 156 patients(11.0%)developed pulmonary infection,including 38 patients(8.9%)in the LMA group and 118 patients(11.9%)in the ETT group.There was no statistically significant difference in the incidence of postoperative pulmonary infection between the two groups(P > 0.05).79patients(8.0%)in the ETT group and 5 patients(1.2%)in the LMA group were transferred to ICU.The median length of stay and postoperative length of stay were 17days(IQR: 14-21 days)and 12 days(IQR: 10-16 days)in the ETT group,and 15 days(IQR: 13-19 days)and 11 days(IQR: 8-14 days)in the LMA group,respectively.There were significant differences in transfer to ICU,length of hospital stay and postoperative hospital stay between the two groups(P < 0.05).After propensity score matching,403 pairs were obtained,including 388 males and 418 females,with a median age of 63 years(IQR: 53-71 years).Postoperative pulmonary infection occurred in 39 patients(9.7%)in the ETT group and 37 patients(9.2%)in the LMA group,and there was no significant difference in the incidence of postoperative pulmonary infection between the two groups(P > 0.05).The number of patients transferred to ICU in ETT group and LMA group were 20(5.0%)and 5(1.2%)respectively,and the difference was statistically significant(P < 0.05).There was no difference in hospital stay and postoperative hospital stay between the two groups(P > 0.05).2.The results of multivariate logistic regression analysis showed that the modes of operation,duration of anesthesia,smoking and postoperative transfer to ICU were the risk factors of pulmonary infection in patients undergoing cholangiolithotomy,and the area under the ROC curve was 0.716(95% CI: 0.671-0.760).there was no significant difference in postoperative pulmonary infection between the two groups(OR= 1.378,95% CI: 0.938-2.025;P > 0.05).After matching,the confounding factors were corrected by the same method as above.The result showed that diabetes mellitus,blood loss ≥ 400 ml,modes of operation and duration of anesthesia were the risk factors of pulmonary infection after choledocholithotomy.The area under the ROC curve was 0.714(95% CI: 0.651-0.777).There was no significant difference in the incidence of postoperative pulmonary infection between the LMA and ETT groups(OR= 1.060,95 %CI: 0.661-1.700;P > 0.05).3.Subgroup analysis of patients before and after PSM showed that there was no association between different ventilation tools and postoperative pulmonary infection in each subgroup(P > 0.05).ConclusionDuring choledocholithotomy,there was no difference in the incidence of pulmonary infection and length of hospital stay between the use of endotracheal intubation and laryngeal mask airway,and the laryngeal mask airway can not reduce the incidence of postoperative pulmonary infection.The modes of operation,the duration of anesthesia,smoking and postoperative transfer to ICU are the risk factors of postoperative pulmonary infection in patients undergoing choledocholithotomy. |
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