Abstract：
Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (N = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, p = 0.005) and a difficult airway (OR 2.869, p = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, p = 0.006). A difficult airway (OR 4.711, p = 0.03) and postoperative delirium (OR 6.761, p = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, p = 0.001) and length in ICU (OR 1.039, p = 0.009) while decreasing in ET group (HR 0.32, p = 0.02). OR for ET increased with mounting CCI (OR 1.462, p = 0.002) and preoperative radiotherapy (OR 2.8, p = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP.
摘要：
选择性气管切开术（ET）可确保气道安全，并防止不良气道相关事件如计划外二次气管切开术（UT），长时间通气（PPV）或医院感染。这项研究的主要目的是确定重建下ja手术后气道并发症的诱发因素。我们回顾了接受下颌骨切除术和微血管骨重建的患者的记录（N=123）。流行病学因素,关于ET和UT的气管切开术方式，记录术后通气时间和医院获得性肺炎HAP的发生情况.PPV和HAP的预测值，确定了ET和UT。共有82例（66.7％）患者进行了气管切开术，其中12例（14.6％）作为UT进行。共有52例(42.3%)患者出现PPV,19人（15.4%）发展了HAP。手术时间增加（OR1.004，p=0.005）和气道困难（OR2.869，p=0.02）是预测因素，ET降低了PPV的发生率（OR0.054，p=0.006）。困难的气道（OR4.711，p=0.03）和术后谵妄（OR6.761，p=0.01）增加了UT表现。HAP在ICU中随麻醉诱导时间（OR1.268，p=0.001）和长度（OR1.039，p=0.009）而增加，而ET组降低（HR0.32，p=0.02）。ET的OR随CCI的安装（OR1.462，p=0.002）和术前放疗（OR2.8，p=0.018）而增加。对于CCI升高，术前放疗和手术时间延长的患者，应充分考虑ET。ET缩短了术后通气时间，降低了HAP。
