小脑幕下占位病变患者的气管切开时机与预后关系的研究  

The effect of timing of tracheostomy on clinical outcomes in patients with infratentorial lesions

作　　者：黄华玮 张国滨[2] 唐思魏 张昀昇 泮长存[2] 陈光强[1] 周建新[1] Huang Huawei;Zhang Guobin;Tang Siwei;Zhang Yunsheng;Pan Changcun;Chen Guangqiang;Zhou Jianxin(Department of Intensive Care Unit,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,100070 [2]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经外科杂志》2019年第6期592-596,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨小脑幕下占位病变患者的气管切开时机对临床预后的影响。方法回顾性纳入2015年1月至2017年12月首都医科大学附属北京天坛医院重症医学科(ICU)行气管切开的253例小脑幕下占位切除术后患者。按照术后至气管切开的时间,将患者分为早期气管切开组(≤7d,共128例)和晚期气管切开组(>7d,共125例)。比较两组患者的机械通气时间、肺部感染的发生率、ICU停留时间以及住院天数。结果相对于早期气管切开组,晚期气管切开组患者的总机械通气时长[中位数(四分位数)][7(3.0,12.0)d对比0(0,5.8)d]、ICU停留时间[19(15.0,25.5)d对比9(8.0,12.0)d]以及住院天数[31(27.0,39.5)d对比20(17.0,24.0)d]均显著延长,差异均有统计学意义(均P<0.001);其肺部感染的发生率显著增加[(88.0%(110/125)对比30.5%(39/128)(P<0.01)]。结论对于小脑幕下占位病变术后患者,早期(≤7d)行气管切开可以减少患者肺部感染的发生率,缩短机械通气时间和ICU停留时间以及住院天数。Objective To determine the effect of timing of tracheostomy on clinical outcome in neurosurgical patients with infratentorial lesions admitted to the intensive care unit (ICU). MethodsA total of 253 neurosurgical patients with infratentorial lesions,who underwent tracheostomy at Department of Intensive Care Unit (ICU),Beijing Tiantan Hospital from January 2015 to December 2017,were enrolled into this study. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 7 days after operation in the early group (group E,n=128),whereas in the late group,it was performed after 7 days post operation (group L,n=125). Total duration of mechanical ventilation (MV),length of stay (LOS) at ICU,hospital LOS,and incidence of ventilator-associated pneumonia (VAP) were compared between the 2 groups. ResultsThe total MV duration,ICU and hospital LOS were significantly longer in group L than in group E [M(P25,P75): 7 (3.0,12.0) d vs. 0 (0,5.8) d;19 (15.0,25.5) d vs. 9 (8.0,12.0) d,31 (27.0,39.5) d vs. 20 (17.0,24.0) d,respectively,all P<0.001]. The incidence of VAP was higher in group L than in group E [88.0%(110/125) vs. 30.5%(39/128),P<0.01]. ConclusionEarly (within 7 days) tracheostomy could reduce the MV duration,ICU LOS and incidence of VAP in critically ill neurosurgical patients with infratentorial lesions.

关 键 词：幕下肿瘤 重症监护病房 气管切开术 手术时机 预后 

分 类 号：R739.41[医药卫生—肿瘤]