摘要
目的 探讨胸腔镜食管癌根治术患者术后延迟拔管的危险因素，并构建预测模型。方法 选择2023年1月至2024年10月于我院行胸腔镜食管癌根治术的285例患者临床资料。根据术后拔管时间分为两组：延迟拔管组（＞1h，n=111）和非延迟拔管组（≤1h，n=174）。采用单因素分析延迟拔管相关的影响因素，多因素Logistic回归分析筛选延迟拔管的独立危险因素并建立预测模型，绘制受试者工作特征（ROC）曲线评价模型的效能。结果 多因素分析显示，年龄、ASA分级≥III级、手术时间、术中尿量、术中使用神经阻滞是术后延迟拔管的预测因素（P＜0.05）。预测模型的AUC为0.784（95%CI0.727～0.841，P＜0.05），表明该预测模型对胸腔镜食管癌根治术患者术后延迟拔管的预测具有重要临床价值。结论 年龄、ASA分级≥III级、手术时间、术中尿量、术中使用神经阻滞是接受胸腔镜食管癌根治术的患者术后延迟拔管的独立预测因素（P＜0.05）。基于以上因素建立的模型具有较好的预测价值。
关键词： 食管癌；胸腔镜手术；延迟拔管；预测模型
Abstract
Objective To explore the risk factors for delayed extubation after thoracoscopic radical resection of esophageal cancer and to construct a predictive model. Methods The clinical data of 285 patients who underwent thoracoscopic radical resection of esophageal cancer in our hospital from January 2023 to October 2024 were selected. The patients were divided into two groups based on the extubation time after surgery: the delayed extubation group (>1 hour, n=111) and the non-delayed extubation group (≤1 hour, n=174). Univariate analysis was used to identify the factors related to delayed extubation, and multivariate Logistic regression analysis was conducted to screen the independent risk factors for delayed extubation and establish a predictive model. The receiver operating characteristic (ROC) curve was drawn to evaluate the performance of the model. Results Multivariate analysis showed that age, ASA grade ≥ III, operation time, intraoperative urine output, and intraoperative use of nerve block were predictive factors for delayed extubation (P < 0.05). The AUC of the predictive model was 0.784 (95% CI 0.727 - 0.841, P < 0.05), indicating that the predictive model has significant clinical value in predicting delayed extubation after thoracoscopic radical resection of esophageal cancer. Conclusion Age, ASA grade ≥ III, operation time, intraoperative urine output, and intraoperative use of nerve block are independent predictive factors for delayed extubation in patients undergoing thoracoscopic radical resection of esophageal cancer (P < 0.05). The model established based on these factors has good predictive value.
Key words： Esophageal cancer; Thoracoscopic surgery; Delayed extubation; Predictive model
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