急危重气管切开患者拔管失败的临床特点分析  

Clinical analysis of extubation failure in critically ill patients with tracheotomy

作　　者：倪军喜[1] 方晨光 李毅[2] 

机构地区：[1]安徽省池州市人民医院急诊内科,安徽池州247100 [2]北京协和医院急诊科,北京100730

出　　处：《中国中西医结合急救杂志》2017年第6期608-612,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金（81550034）

摘　　要：目的 分析急危重气管切开患者拔管失败的临床特点,为提高气管切开拔管成功率提供理论依据.方法 回顾性分析2014年1月至2017年1月安徽省池州市人民医院急诊内科收治的急危重气管切开患者52例;其中拔管失败组14例（无法堵管,堵管失败需再次气管切开或插管）,拔管成功组38例（试堵管24~48 h后,拔除气管切开套管,切口愈合良好,3个月内无因呼吸困难、肺部感染等原因再次气管插管或切开）.比较两组患者性别、年龄、堵管前3 d内意识状态、咳嗽情况、血清白蛋白（Alb）、钠和钾以及B型脑钠肽（BNP）、血红蛋白（Hb）水平的差异,分析拔管失败的临床特点.对各病种进行描述性分析.结果 拔管成功组清醒患者数（24例比4例）、咳嗽功能良好患者数（38例比3例）均明显多于拔管失败组,血清Alb（g/L：35.13±3.13比27.50±5.53）和Hb（g/L：112.18±13.62比94.14±17.03）均明显高于拔管失败组,BNP明显低于拔管失败组（ng/L：344.03±152.85比5887.80±2695.97,P〈0.05）.拔管失败组患者的原发病有：脑卒中7例,特重型颅脑损伤3例,呼吸衰竭（呼衰）3例,心肺复苏（CPR）术后1例.说明脑卒中、特重型颅脑损伤、呼衰和CPR术后是拔管失败的常见病种.结论 拔管前充分评估患者,对合并昏迷,咳嗽功能差,低蛋白血症,心功能不全和贫血患者应尽早采取措施,以提高拔管成功率.Objective To analyze the clinical features of extubation failure in critically ill patients with tracheotomy in order to improve the success rate of tracheal extubation.Methods The clinical data of 52 critically ill patients with tracheotomy admitted to the Department of Emergency Internal Medicine of Chizhou People＇s Hospital of Anhui Province from January 2014 to January 2017 were retrospectively analyzed; there were 14 cases in failed extubation group （extubation failure： unable to plug the pipe, necessary to be cut or intubated again）, and 38 cases were in successful extubation group （success criteria： after trying plugging the pipe for 24 - 48 hours, pulling out sleeving tube of tracheal incision, the incision healed well, within 3 months no dyspnea or pulmonary infection necessary to again performing tracheal intubation or incision）. The differences in gender, age, within 3 days before plugging the pipe the consciousness, cough condition, the levels of serum albumin （Alb）, serum potassium and serum sodium, brain natriuretic peptide （BNP）, hemoglobin （Hb） were compared between the two groups, the clinical characteristics of extubation failure were analyzed, and the descriptions and their numbers for all diseases resulting in extubation failure were carried out.Results The number of conscious patients （24 cases vs. 4 cases）, and the number of patients with good cough function （38 cases vs. 3 cases） were obviously more in successful extubation group than those in the failed extubation group, and the levels of serum Alb （g/L： 35.13±3.13 vs. 27.50±5.53）, Hb （g/L： 112.18±13.62 vs. 94.14±17.03） in successful extubation group were significantly higher than those in failed extubation group （allP〈 0.05）. BNP was significantly lower in successful extubation group than that in failed extubation group （ng/L： 344.03±152.85 vs. 5887.80±2695.97,P 〈 0.05）. The common diseases in extubation failure group were as follows： stroke in 7 cases, special severe cra

关 键 词：气管切开 急危重症 拔管失败 

分 类 号：R472.9[医药卫生—护理学]