神经危重症患者拔除气管插管影响因素的研究  

Research on relevant factors affecting results of extubation of trachea cannula in neurocritical carepatients

作　　者：田歌[1,2] 潘速跃[1] 廖伟[2] 苏全冠[2] 顾葆春[2] 吴永明[1] 姬仲[1] 王静新[1] 马刚[2] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]中山大学肿瘤防治中心华南肿瘤学国家重点实验室重症医学科

出　　处：《中华急诊医学杂志》2012年第12期1314-1318,共5页Chinese Journal of Emergency Medicine

摘　　要：目的研究影响神经危重症患者拔除气管插管成功率的相关因素。方法本研究为回顾性、描述性研究。纳入2008年12月至2011年2月，南方医院神经内科重症监护病房收治的40名因中枢神经系统疾病需行气管插管，且插管时间大于6h的患者。排除了资料不完整，及治疗无效或脑死亡或个别拔除气管插管后立即行气管切开的患者。按拔管是否成功分为两组。比较两组患者拔除气管插管前的基本临床资料、呼吸参数、24h出入量、痰液情况、格拉斯哥昏迷评分（GCS）及四分法评分（Four Scale）之间的差异，采用SPSS13．0统计软件分析处理数据。结果GCS评分及Four评分在拔管成功及拔管失败两组患者中差异具有统计学意义（P均〈0．05），且在评估拔管结果时效能差异具有统计学意义（P=0．012），并与插管结果存在显著相关性（P=0．041），发生癫痫在两组间差异亦有统计学意义。而其他因素对于预测拔管能否成功暂无统计学意义。结论本研究表明，GCS评分及Four评分对于预测神经危重症患者拔管能否成功存在意义，而患者的人口学数据及常用呼吸参数及痰液性状、痰液量、24h出入量等在传统拔管指征基础上的分级研究对于预测拔管能否成功暂无明确意义。而其他因素对NICU患者，能否起到预测拔管失败的作用，尚需要更多前瞻性、随机对照研究的进行。Objective To Explored the relative factors which caused the extubation failure in neurological intensive care unit （NICU）. Methods It was a retrospective study . 40 cases of patients who met the criteria, were brought into statistical analysis . They were admitted in NICU in Nan Fang Hospital from December 2008 to February 2011 . The name, sex, age, diagnosis, respiratory parameters, 24 hours discrepancy quantity, sputum, and Glasgow Coma Scale, Full Outline of UnResponsiveness Scale were recorded. SPSS 13.0 was used as statistic software . P 〈 0. 05 was considered statistically significant. Results Both in extubation successful and failure groups, GCS and Four were significantly different （ all P 〈0. 05 ）. Howerer, there were no statistically significant in the other factors . There were significantly differences between GCS and Four in predicting extubation results （P =0. 012）. Logistic multiple regression showed that Four and GCS grade were predictive factor of extubation failure （P = 0. 041 ）. Conclusions The result suggests that it is statistically significant to use GCS and Four as factors to predict extubation results . It can be widely used to help medical personnels monitoring the changes of patients＇clinicalconditions, judging prognosis, and making treatment plan in NICU . Wether other factors would effect the extubation results, more prospective, randomized controlled studies were needed .

关 键 词：神经危重症 拔除气管插管 成功率 失败率 格拉斯哥昏迷评分 四分法评分 回顾性 影响因素 

分 类 号：R459.7[医药卫生—急诊医学]