机械通气重症患者气管切开时机的研究进展  

作　　者：林影芯[1] 罗华[1] 张卫星[1] 

机构地区：[1]北京大学深圳医院重症医学科,广东518036

出　　处：《当代医学》2014年第35期9-10,共2页Contemporary Medicine

摘　　要：随着重症医学发展,越来越多的患者需要长期气管插管和机械通气。当预计机械通气的时间超过数周,应当考虑气管切开,但是何时进行气管切开仍存在争议。虽然有许多随机对照研究和荟萃分析探讨气管切开的时机,大部分并不能证明早期气管切开的好处。早期行气管切开与晚期相比,早期行气管切开可增加患者机械通气的舒适度,镇静药物的使用有减少的趋势,但是早期气管切开并不能降低呼吸机相关性肺炎的发生率及机械通气的时间,对重症监护病房留治时间和住院时间均无影响,且不能降低重症机械通气患者的死亡率。针对特定人群的研究提示急性神经系统疾病的患者可能从早期气管切开获益。Advances in treating the critically ill have resulted in more patients requiring prolonged airway intubation and respiratory support. If mechanical ventilation is projected to be longer than several weeks, tracheotomy is often recommended. There is controversy, however, over the optimal timing of the procedure. While there have been many randomized controlled trials and several meta-analysis on tracheotomy timing, most were insufficiently powered to detect important differences. Compared to late tracheotomy, early tracheotomy could improve patient comfort and possibly reduce the administration of sedatives, but it suggested that the timing of tracheotomy did not reduce the incidence of ventilator-associated pneumonia, the duration of mechanical ventilation, the duration of intensive care unit（ICU） and hospital stay , or the long term mortality in critically ill patients. Studies on specific population indicated patients with acute neurological disease may benefit from early tracheotomy.

关 键 词：机械通气 气管切开术 时机 

分 类 号：R459.7[医药卫生—急诊医学]