对老年患者临终前气管插管的回顾性调查  

Tracheal intubation in elderly patients before death:a retrospective survey of 65 cases

作　　者：李小梅 黄海力 崔明新 宋昱 邱娇娇 范利 LI Xiao-Mei;HUANG Hai-Li;CUI Ming-Xin;SONG Yu;QIU Jiao-Jiao;FAN Li(Department of Geriatrics,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Oncology,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心老年医学科,北京100853 [2]中国人民解放军总医院第二医学中心肿瘤内科,北京100853 [3]中国人民解放军总医院第二医学中心国家老年疾病临床医学研究中心,北京100853

出　　处：《中华老年多器官疾病杂志》2022年第11期817-821,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点研发计划(2020YFC2008900);中央保健科研课题(2020YBA15)。

摘　　要：目的比较缓和医疗理念推广前后老年患者临终前气管插管率有无显著变化。方法回顾性调查2008年1月至2017年12月于中国人民解放军总医院第二医学中心年龄≥65岁的死亡患者,分为肿瘤组和非肿瘤组,逐年统计气管插管率,并比较2014年前后有无变化及2组患者临终前插管率和插管后生存期有无差异。采用SPSS 21.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ2检验。结果共收集死亡患者1233例,男性1150例(93.27%),女性83例(6.73%);肿瘤患者456例(36.98%),非肿瘤患者777例(63.02%)。肿瘤组的平均年龄明显低于非肿瘤组,肿瘤低龄组的比例显著高于非肿瘤组,差异均有统计学意义(均P<0.05)。965例(78.26%)接受临终前气管插管,其中肿瘤组占29.22%(282/965),非肿瘤组占70.78%(683/965)。肿瘤组的整体插管率为61.84%(282/456),非肿瘤组的整体插管率为87.90%(683/777),2组插管率差异有统计学意义(P<0.01)。2014年前后对比,无论是整体插管率、肿瘤组还是非肿瘤组,自身前后对比都存在显著差异[557(82.76%)和408(72.86%),194(69.04%)和88(50.29%),363(92.60%)和320(83.12%);P<0.01]。肿瘤组插管后平均生存期(108.09±16.40)d,非肿瘤组为(273.93±20.20)d,差异有统计学意义(P<0.01)。插管后1个月以内死亡的患者,肿瘤组为56例(54.96%),非肿瘤组为100例(42.90%)。肿瘤患者插管后生存1年以上的比例为19例(6.74%),非肿瘤患者为146例(21.38%),差异有统计学意义(P<0.01)。结论我中心临终前老年患者的整体气管插管率较高。自2014年缓和医疗理念普及后,无论肿瘤还是非肿瘤患者,临终前的气管插管率都显著降低。非肿瘤患者插管后的生存期明显长于肿瘤患者。要建立科学的评价体系,严格评估插管的必要性。Objective To compare if there is a significant change in the rate of tracheal intubation at terminal period in elderly patients before and after the promotion of the concept of “palliative care”. Methods A retrospective study was conducted to investigate the medical records of dead patients aged ≥65 years who died in our medical center from January 2008 to December 2017. The patients were divided into cancer group and non-cancer group. The rate of tracheal intubation in the 2 groups was recorded year by year, and the rate was compared before and after 2014. And the intubation rate and survival time after intubation were also compared. SPSS statistics 21.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test or Chi-square test depending on data types. Results Finally, medical data of 1 233 dead elderly patients were collected, including 1 150 males(93.27%) and 83 females(6.73%), and 456 cases(36.98%) of them were cancer patients and 777 cases(63.02%) were non-cancer patients. The patients of the cancer group had a significantly younger mean age and larger proportion of younger age subgroup when compared with those of the non-cancer group(both P<0.05). Among the 965 cases(78.26%) receiving tracheal intubation, 29.22% cases(282/965) of them were from the cancer group, and 70.78%(683/965) from the non-cancer group. The rate of tracheal intubation was 61.84%(282/456) in the cancer group and 87.90%(683/777) in the non-cancer group, with statistical difference between them(P<0.01). When the conditions were compared before and after 2014, significant differences were seen not only in the overall rate of tracheal intubation [557(82.76%) vs 408(72.86%)], but also in the rate of the cancer group [194(69.04%) vs 88(50.29%)] and that of the non-cancer group [363(92.60%) vs 320(83.12%), all P<0.01]. The mean survival time after intubation was(108.09±16.40) d in the cancer group and(273.93±20.20) d for the non-cancer group, and the difference was statistically signif

关 键 词：终末期 气管插管 恶性肿瘤 非恶性肿瘤 生存期 

分 类 号：R48[医药卫生—临床医学]