Research Of Risk Factors Of Tracheal Reintubation For Postoperative Patients And Effects Of Continuous Nebulization Therapy

Objective1. To explore the risk factors of tracheal reintubation for patients after liver transplantation.2. To explore the effects of continuous nebulization therapy for promoting expectoration in postoperative patients after tracheal extubation.Methods1. The data about 237 patients with liver transplantation from January, 2004 to December, 2009 in Eastern Hepatobiliary Surgery Hospital were collected, including clinical data, laboratory results and complications during and after operation. The data were analyzed by SPSS PASW(18.0), and method of Logistic regression analysis was used to investigate the risk factors of tracheal reintubation of patients after liver transplantation.2. 102 postoperative patients after tracheal extubation were randomized into continuous nebulization group (Mucosolvan 120mg + Atrovent 2mg + sterile water 400ml, continuous nebulization for 48h ) and discontinuous nebulization group (Mucosolvan 30mg + Atrovent 0.5mg + sterile water 5ml, 4/d). The frequency of effective expectoration, total volume of sputum, results of arterial blood gas analysis, SpO2, respiratory rate, comfort level in 48h after extubation were compared using the Independent-Samples T Test, and stickiness of sputum respectively at 0h, 2h, 6h, 12h, 24h, 48h after extubation were compared using Repeated Measurement data ANOVA, and the rate of sputum retention, effective nebulization,pulmonary infection and reintubation of the two groups were compared using Pearsonχ2 test or Fisher exact test in the analysis.Results1. 30 patients (12.7%) were reintubated after liver transplantation. According to Logistic regression analysis, the risk factors for reintubation after liver transplantation include preoperative grade of liver function(Child-pugh C), (OR=12.597, 95%CI:2.686-41.814,P=0.001), intraoperative hypotension, (OR=15.916, 95%CI:2.340-108.229,P=0.005), postoperative complications such as pulmonary infection (OR=28.641, 95%CI :2.561-320.328,P=0.006) and renal function failure( OR=8.159, 95%CI:1.320-50.447,P=0.024),high volume of sputum in 3 days after operation, (OR=2.002,95%CI: 1.135-3.532,P=0.017) .2. The frequency of effective expectoration and total volume of sputum in 48h after extubation in continuous nebulization group were more than that in discontinuous nebulization group, and the effect of decreasing stickiness of sputum was better than that in discontinuous nebulization group, and the rate of effective nebulization were higher than that in discontinuous nebulization group, and the rate of sputum retention, pulmonary infection were lower than that in discontinuous nebulization group, (P<0.05). But there was no statistical difference in the result of arterial blood gas analysis, SpO2, respiratory rate, comfort level in 48h after extubation,tracheal reintubation rate and hospital mortality between the two groups (P>0.05).Conclusion1. To improve the preoperative liver function, to control the intraoperative bleeding, to promote the expectoration after extubation and to prevent the postoperative complications such as pulmonary infection and renal failure are helpful to decrease the incidence of tracheal retintubation in patients after liver transplantation.2. Continuous nebulization therapy (Mucosolvan 120mg + Atrovent 2mg + sterile water 400ml) given within 48h after tracheal extubation in postoperative patients is safe, and it can promote expectoration after extubation and prevent pulmonary infection. But its effect for preventing reintubation needs to be studied by further research.