神经重症患者气管切开的预测因素分析  

Analysis of predictive factors of tracheotomy in severe neurological 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,China)

机构地区：[1]成都市新都区人民医院重症医学科,成都610500

出　　处：《临床急诊杂志》2022年第2期147-150,共4页Journal of Clinical Emergency

基　　金：四川省卫生和计划生育委员会科研课题(No:17PJ145)。

摘　　要：目的:探索神经重症患者气管切开预测因素。方法:收集2019年1月1日-2019年12月31日期间我院重症医学科病房的117例神经重症患者的病例资料。根据纳入、排除标准,最终纳入研究对象66例,根据患者住院期间是否行气管切开分为气管切开组(T组,35例)和未行气管切开组(NT组,31例)。比较两组患者性别、年龄、神经重症类型、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)及气管切开预测因素(损伤部位、弥漫性病变、脑积水、PaO_(2)/FiO_(2)<150),对预测因素进行二元logistic回归分析。结果:T组和NT组比较T组患者入院时男性更多,GCS评分更低,APACHEⅡ评分更高,脑干、大脑脑室及脑室周围区域损伤占比更高,弥漫性病变占比更高,差异有统计学意义。多因素回归分析显示,脑干损伤(P=0.004)、大脑脑室及脑室周围区域[OR=0.103(0.026~0.419),P=0.001]、弥漫性病变[OR=0.030(0.003~0.284),P=0.002]是神经重症患者气管切开的独立预测因素。结论:脑干损伤、大脑脑室及脑室周围区域损伤、弥漫性病变是神经重症患者气管切开的预测因素。Objective:To explore the predictive factors of tracheotomy in patients with severe neurological diseases.Methods:From January 1,2019 to December 31,2019,patients in intensive care unit(ICU)of our hospital were divided into tracheotomy group(T Group)and non tracheotomy group(NT group)according to whether they underwent tracheotomy during hospitalization.Gender,age,type of neurological severity,APACHEⅡscore,GCS score and predictive factors of tracheotomy(injury site,diffuse lesions,hydrocephalus,PaO_(2)/FiO_(2)<150)were compared between the two groups,and binary logistic regression analysis was performed on the predictive factors.Results:Compared with NT group,T group had more males at admission,lower GCS score,higher APACHEⅡscore,higher proportion of brain stem,brain ventricle and periventricular area injury,and higher proportion of diffuse lesions.The difference was statistically significant.Multivariate regression analysis showed that brainstem injury(P=0.004),cerebral ventricle and periventricular area[OR=0.103(0.026-0.419),P=0.001]and diffuse lesions[OR=0.030(0.003-0.284),P=0.002]were independent predictors of tracheotomy in patients with severe neurological diseases.Conclusion:Brain stem injury,brain ventricle and periventricular area injury and diffuse lesions are predictive factors of tracheotomy in patients with severe neurological diseases.

关 键 词：神经重症 气管切开 预测因素 

分 类 号：R473.6[医药卫生—护理学]