Analysis Of Risk Factors And Interventional Therapy Of Tracheal Stenosis After Intubation

Background and objectives: Endotracheal intubation often used to rescue critically ill patients,is one of the main methods to improve respiratory function effectively,but it will cause intubation in patients with tracheal stenosis,recurrent cough,dyspnea,cyanosis,respiratory failure and even cause the death of the patient.With the extensive application of rescue techniques and respiratory support levels in medical institutions at all levels,tracheal intubation or tracheotomy is increasingly used in clinical and iatrogenic factors of tracheal stenosis is also increasing.For the benign stenosis caused by tracheal intubation,surgical treatment was used mainly in the past,however,there are some factors limit the operation,such as large operative trauma,postoperative complications,long postoperative recovery time and some patients are unable to operate or refuse surgery because of the narrow position,basic disease and other factors.With the continuous improvement of airway interventional techniques,interventional therapy has become an important treatment for tracheal stenosis at present.The therapeutic effect of interventional therapy on benign tracheal stenosis is good,but partial recurrence and poor long-term effect are still a major problem in clinical interventional therapy.In this study,we reviewed the clinical data of tracheal stenosis after tracheal intubation,discussed the risk factors of tracheal stenosis after intubation,the clinical characteristics,the efficacy of interventional therapy and the factors influencing the interventional therapy.Part One: Analysis of risk factors of tracheal stenosis after tracheal intubationObjective : To investigate the risk factors of tracheal stenosis after tracheal intubation.Methods:A single and multiple factor Logistic regression were used to analyze the risk factors in 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015?Results:Univariate analysis showed that diabetes,smoking,intubation time(>7days),large catheterization catheter(catheter ID ?8mm in male and ?7.5mm in female),recurrent respiratory tract infection were the influence factors of tracheal stenosis in 69 patients with tracheal stenosis after intubation and 50 cases without tracheal stenosis after tracheal intubation(P<0.05).Multivariate Logistic regression analysis showed that diabetes,intubation time(>7days),large catheterization catheter(catheter ID ?8mm in male and ?7.5mm in female)and recurrent respiratory tract infection were positively correlated with tracheal stenosis after tracheal intubation,the values of OR and 95%CI were 2.819(1.972-4.067),6.573(3.016-14.325),3.562(2.218-5.730),13.174(6.218-27.956),respectively.The ROC curve was used to evaluate the effect of Logistic regression model,and its AUC and 95%CI were 0.912(0.861 ~ 0.989)Conclusions : Diabetes mellitus,intubation time(>7days),large catheterization catheter(catheter ID ?8mm in male and ?7.5mm in female)and recurrent respiratory tract infection are risk factors of tracheal stenosis after tracheal intubation.Part Two: The effect of interventional therapy in patients with tracheal stenosis after intubationObjective:To investigate the effect and treatment of interventional therapy for patients with tracheal stenosis after intubation.Methods:A retrospective analysis was made to the therapeutic interventional therapy effect and treatment of 69 patients with tracheal stenosis after tracheal intubation.Results:In the 69 cases of tracheal stenosis after endotracheal intubation,36 cases were male and 33 cases were female,the median 44 old-year and a total of 275 times of respiratory intervention were received,averaging 3.98 times / case.After treatment of interventional therapy patients with symptoms of shortness of breath relief.Dyspnea score decreased from(2.41±0.76)points to(0.65±0.62)points(P<0.01),the diameter of airway lumen increased from(4.24±2.05)mm to(10.57±3.14)mm(P<0.01).The immediate effective rate of interventional therapy was 92.8%(64/69),and the ratio of restenosis was 56.5%,26.1% and 36.2% in 1 months,3 months,and 1 years after treatment respectively.Conclusions:The short-term effect of interventional therapy for tracheal stenosis after tracheal intubation is good,but the recurrence rate is still high.Part Three: Influencing factors of interventional therapy in patients with tracheal stenosis after intubationObjective:To investigate the influencing factors of interventional therapy in patients with tracheal stenosis after intubationMethods:Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of interventional therapy in 69 patients with tracheal stenosis.Results:Single factor analysis showed that smoking,diabetes,dyspnea score greater than 3 scores,tracheal stenosis diameter less than 4.5mm,classification of tracheal stenosis more than 4 level classification,stenosis located in the upper segment of the trachea and recurrent respiratory infection were independent factors of Interventional treatment for tracheal stenosis,but there was no significant difference in age,sex,hypertension,coronary heart disease,tracheal stenosis in the middle or lower segments and the use of local drugs multivariate logistic regression analysis showed that diabetes(OR=2.819,95%CI 1.973-4.062),dyspnea score greater than 3 scores(OR=13.816,95%CI 5.848-32.641),tracheal stenosis diameter less than 4.5mm(OR=7.482,95%CI 4.015-13.943),classification of tracheal stenosis more than 4 level classification(OR=3.815,95%CI 2.258-6.447),stenosis in the upper trachea(OR=5.173,95%CI 3.218-8.316)were risk factors of interventional therapy for post-intubation tracheal stenosis.ROC curve to evaluate the Logistic regression model to predict the effect under the curve of area(AUC)and 95%CI were 0.908(0.854-0.985).Conclusions : Diabetes,dyspnea score greater than 3 scores,tracheal stenosis diameter less than 4.5mm,classification of tracheal stenosis more than 4 level classification and stenosis in the upper trachea may be important factors that affect the efficacy of interventional therapy for tracheal stenosis after tracheal intubation.