全国各级医疗机构关于气管切开套管拔管临床实践情况的调查  

A survey on clinical practice of tracheostomy decannulation in medical institutions at all levels across the country

作　　者：牛光宇 连素娜 刘仲楠 郄淑燕 席家宁[1] 童朝晖 姜宏英 Niu Guangyu;Lian Suna;Liu Zhongnan;Qi Shuyan;Xi Jianing;Tong Zhaohui;Jiang Hongying(Department of Pulmonary and Critical Care Medicine,Beijing Rehabilitation Hospital of Capital Medical University,Beijing 100144,China;Department of Rehabilitation Clinic,Beijing Rehabilitation Hospital of Capital Medical University,Beijing 100144,China;Department of Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京康复医院呼吸与危重症医学科,北京100144 [2]首都医科大学附属北京康复医院康复诊疗中心,北京100144 [3]首都医科大学附属北京朝阳医院北京市呼吸疾病研究所,北京100020

出　　处：《中华结核和呼吸杂志》2022年第8期762-767,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的调查全国各级医疗机构医务人员气管切开套管拔管临床实践情况。方法通过文献回顾法及专家咨询法确定调查问卷,调查全国不同等级综合和康复医院医务人员的气管切开套管拔管临床实践情况以及决定拔管时的考虑因素。统计学方法采用χ^(2)检验和单因素方差分析。结果共收集问卷570份,有效问卷463份,调查结果显示医务人员决定拔管时考虑因素最重要的依次为上气道通畅性、咳嗽能力、意识水平和氧合情况。在气管切开套管拔管前,463名医务人员中,220名(47.50%)会更换为金属套管,384名(82.90%)会常规堵管,294名(63.50%)认为气管切开套管拔管后24 h内再次插管为拔管失败。各中心的拔管失败率多为2%~5%。结论调查显示决定拔管时考虑因素按重要性依次为上气道通畅性、咳嗽能力、意识水平及氧合情况。大多数参与调查的人员界定气管切开套管拔管失败为拔管后24 h内重新插管。Objective A questionnaire survey was conducted on the clinical practice of tracheostomy decannulation among medical staff in medical institutions at all levels across the country.Methods The questionnaire was determined by literature review and expert consultation to investigate the clinical practice of tracheostomy decannulation among medical staff in comprehensive and rehabilitation hospitals of different levels across the country and the factors considered when deciding to decannulate.Statistical methods usedχ^(2)test and one-way ANOVA.Results A total of 570 questionnaires were collected from all over the country,with 463 valid questionnaires.The survey results showed that the most important factors in clinical practice to determine the decannulation of the tracheostomy tube were upper airway patency,cough effectiveness,level of consciousness and oxygenation.Before decannulation,220(47.50%)would choose to change to metal cannula,and 384(82.90%)would routinely occlude the tube.294(63.50%)thought that re-intubation within 24 hours after decannulation of the tracheostomy tube was failure of decannulation.The decannulation failure rate was mostly 2%-5%.Conclusions Upper airway patency,cough effectiveness,level of consciousness and oxygenation were important factors when considering decannulation.Reintubation within 24 hours of decannulation was defined as failure by the majority of respondents.

关 键 词：气管切开术 问卷调查 拔管 

分 类 号：R459.7[医药卫生—急诊医学]