脑卒中相关早期气管切开评分对神经重症患者气管切开的预测价值  

Predictive value of stroke-related early tracheotomy score for tracheotomy in neurocritical patients

作　　者：雷铃 吴朝文 陈万[1] 罗先海[1] Lei Ling;Wu Chaowen;Chen Wan;Luo Xianhai(Department of Critical Care Medicine,Xindu District People's Hospital of Chengdu,Chengdu 610500,Sichuan,China)

机构地区：[1]成都市新都区人民医院重症医学科,四川成都610500

出　　处：《中华危重病急救医学》2021年第11期1342-1346,共5页Chinese Critical Care Medicine

基　　金：四川省卫生和计划生育委员会科研课题(17PJ145)。

摘　　要：目的探讨脑卒中相关早期气管切开评分(SET评分)对神经重症患者气管切开的预测价值。方法回顾性分析2019年1月1日至12月31日成都市新都区人民医院重症监护病房(ICU)神经重症患者的病例资料。根据住院期间是否行气管切开将患者分为气管切开组和未行气管切开组;以SET评分是否≥10分将患者分为SET评分<10分组和SET评分≥10分组。比较两组患者性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS)、SET评分、ICU住院时间和机械通气时间的差异。用受试者工作特征曲线(ROC曲线)分析SET评分对ICU住院时间>10 d、机械通气时间>5 d和气管切开治疗的预测价值以及APACHEⅡ评分对气管切开治疗的预测价值。结果入选66例神经重症患者,35例接受了气管切开术,31例未行气管切开术;SET评分<10分19例,SET评分≥10分47例。与未行气管切开组比较,气管切开组患者男性更多(例:27比13),GCS评分更低(分:7.00±2.41比11.52±2.00),APACHEⅡ和SET评分更高(分:22.43±4.45比19.58±5.86,16.11±3.67比8.61±4.27),ICU住院时间及机械通气时间更长〔d:27.54±18.82比7.45±5.30,13(9,19)比0(0,2)〕,差异均有统计学意义(均P<0.05)。与SET评分<10分组比较,SET评分≥10分组患者创伤性脑损伤比例、气管切开比例更高(44.68%比15.79%,70.21%比5.26%),GCS评分更低(分:8.00±2.87比11.89±1.97),APACHEⅡ评分更高(分:22.30±4.80比18.11±5.49),ICU住院时间及机械通气时间更长〔d:22.38±18.74比7.53±4.60,9(4,16)比0(0,2)〕,差异均有统计学意义(均P<0.05)。ROC曲线分析显示:SET评分预测神经重症患者ICU住院时间>10 d的曲线下面积(AUC)为0.877,95%可信区间(95%CI)为0.790~0.964(P=0.000),其截断值为13.50分时敏感度为80.0%,特异度为87.1%;SET评分预测机械通气时间>5 d的AUC为0.915,95%CI为0.851~0.979(P=0.000),其截断值为13.50分时敏感度为78.4%,特异度为89.7%。SET评分预测应Objective To explore the predictive value of stroke-related early tracheotomy score(SET)for tracheotomy in neurocritical patients.Methods A retrospective analysis of the clinical data of neurocritical patients admitted to the department of intensive care unit(ICU)of the Xindu District People's Hospital of Chengdu from January 1st to December 31st,2019.Patients were divided into tracheostomy group and non-tracheostomy group according to whether they underwent tracheotomy during hospitalization;according to SET score,patients were divided into groups with SET score<10 points and SET score≥10 points.The differences in gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ),Glasgow coma score(GCS),SET score,the length of ICU stay and mechanical ventilation time were compared between the two groups.The receiver operator characteristic curve(ROC curve)was used to analyze the predictive value of SET score for the length of ICU stay>10 days,mechanical ventilation time>5 days,and tracheotomy treatment,and the predictive value of APACHEⅡscore for tracheotomy treatment.Results Among 66 patients,35 cases underwent a tracheotomy,31 cases did not;SET score<10 points in 19 cases,while SET score≥10 points in 47 cases.Compared with the non-tracheostomy group,there were more male patients in the tracheostomy group(cases:27 vs.13),the GCS score was lower(7.00±2.41 vs.11.52±2.00),the APACHEⅡscore and the SET score were higher(22.43±4.45 vs.19.58±5.86,16.11±3.67 vs.8.61±4.27),and the length of ICU stay and mechanical ventilation time was longer[days:27.54±18.82 vs.7.45±5.30,13(9,19)vs.0(0,2)],and all differences were statistically significant(all P<0.05).Compared with SET score<10 points group,the proportion of traumatic brain injury and tracheotomy in the SET score≥10 points group was higher(44.68%vs.15.79%,70.21%vs.5.26%),the GCS score was lower(8.00±2.87 vs.11.89±1.97),APACHEⅡscore was higher(22.30±4.80 vs.18.11±5.49),and the length of ICU stay and mechanical ventilation time was longer[days

关 键 词：脑卒中相关早期气管切开评分 神经重症 气管切开 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]