ICU机械通气患者气管切开时机的选择  

Timing of tracheostomy in ICU patients with mechanical ventilation support

作　　者：赵秀宝[1] 王勇强[1] 张会云[1] 姚芳超[1] 王兵[1] 

机构地区：[1]天津市第一中心医院ICU,天津300192

出　　处：《中华急诊医学杂志》2017年第2期194-196,共3页Chinese Journal of Emergency Medicine

摘　　要：目的评估气管切开时机对ICU长期机械通气患者的影响。方法回顾性分析2012年1月至2014年10月天津市第一中心医院ICU94例长期机械通气患者，根据气管切开时间分为两组：早期组（A组）定义为气管切开距气管插管的时间≤7d，晚期组（B组）为〉7d。比较两组患机械通气时间、人住ICU时间、总住院时间、呼吸机相关性肺炎（VAP）发生率和病死率，对气管切开距气管插管的时间与机械通气时间及入住ICU时间做相关性分析。结果早期气管切开组较晚期气管切开组机械通气时间、入住ICU时间及VAP发生率明显下降（均P〈0．05），两组患者总住院时间及病死率差异无统计学意义（均P〉0．05），气切时间与机械通气时间和入住ICU时间均有显著相关性（均P〈0．05）。结论早期气管切开可以缩短ICU患者机械通气时间、入住ICU时间和降低VAP发生率。Objective To assess the influence of timing of tracheostomy performed on ICU patients with mechanical ventilation support for long-term. Methods A retrospective study was carried out in 94 patients under mechanical ventilation support with tracheostomy from January 2012 to October 2014. The patients were divided into early stage group （group A） in which the tracheostomy was done within 7 days after endotracheal intubation and late stage group （ group B） in which the tracheostomy was performed at above 7 days after endotracheal intubation. The differences in lengths of mechanical ventilation support （ MVS）, ICU stay, and hospital stay, incidence of ventilator-associated pneumonia （VAP） and mortality were compared between two groups using nonparametric statistics. Results Compared with group B, there were statistically significant reduction in duration of mechanical ventilation （ 7d vs. 17 d; P 〈 0. 05 ）, shorter length of ICU stay （ 10 d vs. 19 d ; P 〈 0. 05 ）, and lower incidence of VAP （ 21.05% vs. 36. 84% ; P 〈 0. 05 ） in group A. There were no significant differences in hospital stay and mortality between two groups （P 〉0. 05）. There was a correlation between the duration of mechanical ventilation and timing of tracheostomy （R2 = 0. 680） and a correlation between the length of ICU stay and the timing of tracheostomy （R2 = 0. 662） was found. Conclusions Early tracheostomy has a significant positive impact on critically ill patients hospitalized in this ICU. These results support the tendency to balance the risk-benefit analysis in favor of early tracheostomy.

关 键 词：气管切开 重症医学 机械通气 呼吸机相关肺炎 

分 类 号：R459.7[医药卫生—急诊医学]