危重患者长期机械通气时气管切开时机的回顾性研究  

Timing of tracheostomy for prolonged mechanical ventilation in unselected critical ill patients

作　　者：陈晓梅[1] 韩辉[1] 董世笑[1] 杜滨锋[1] 

机构地区：[1]山东大学齐鲁医院重症医学科,山东济南250012

出　　处：《中国急救医学》2015年第9期832-836,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的验证早期气管切开与危重患者预后之间的关系。方法回顾性队列研究2010—01—2013—12未经选择的需要长期机械通气I〉48h危重患者。依据气管切开时机的频数分布分为早期组（earlytracheostomy，ET）是机械通气≤5d时进行气管切开的患者和晚期组（1atetracheostomy，LT）是机械通气〉5d时气管切开的患者。两组进行人口学、病因学和ICU死亡率的比较。数据源于电子病历。结果860例进行机械通气的患者中共有234例（27．21％）患者暴露于气管切开并纳入分析。其中早期组159例，晚期组75例。两组间病情严重程度没有差别，从年龄上，老年患者多接受晚期气管切开（P〈0．01），从病因构成上，颅脑外伤和中枢神经疾病患者多接受早期气管切开（P〈0．01）。ICU出院时气管套管带管率两组间相似。ICU全因死亡率分别为早期组20．09％和晚期组11．97％（P=0．2344）。早期组和晚期组ICU住院时间中位数分别是29d和33d（P=0．015），机械通气时间的中位数分别是14．97d和20．69d（P=0．013）。结论5d内进行气管切开的患者与病情改善无关，但能缩短机械通气时间和ICU住院时间。Objective Tracheostomy is a common clinical practice in ICU, but less research was focused on the relationship between the timing of tracheostomy and outcome of severe ill patients in China. This study aims to examine the association between early tracheostomy and mortality in ICU from China. Methods This retrospective observational cohort study was performed at a tertiary -care, university - affiliated hospital. Unselected patients requiring mechanical ventilation for ≥ 48 hours enrolled from January 2010 to December 2013. According to the frequency distribution were classified. Early tracheostomy （ET） is considered if the procedure occurred ~〈 5 days after mechanical ventilation and tracheostomy was considered late （LT） if the procedure occurred 〉 5 days after mechanical ventilation. Data were collected from electronic medical record by senior physicians. Results Of the 860 mechanical ventilation patients screened, 234 （27.21%） received a tracheostomy, and 159 patients received the tracheostomy in early group and 75 patients received of patients＇ illness between the two groups. No significant difference in illness severity were between two groups. Older patients less likely received early tracheostomy （P 〈 0. 01 ） while patients with brain injury or central neurological disease more likely received early tracheostomy （ P 〈 0. O1 ）. The decannulated rate on discharge was similar between two groups. All- cause mortality at ICU discharge was no significantly different between 20. 09% in early group and 11.97% in late group （P = 0. 2344）. Median critical care unit length of stay was decreased for 29 days in early group while 33 days in late group （ P = 0. 015 ）. Median mechanical ventilation period was shorter in early group for 14.97 days than in late group for 20.69 days （ P = 0.013 ）. Conclusion Tracheosotmy within 5 days of critical care admission is not associated with an improvement at ICU discharge, but may benefit from shorter mechanical ventilation period and ass

关 键 词：气管切开 重症监护病房 机械通气 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]