高血压性脑出血开颅术后呼吸机辅助呼吸病人需行气管切开的危险因素分析  

Risk factors for tracheotomy in patients with hypertensive cerebral hemorrhage undergoing ventilator-assisted breathing after craniotomy

作　　者：张卫峰[1] 李锋[1] 王明[1] 顾威庭[1] 仇霁亭 贾丕丰[1] 成侃[1] 蔡瑜[1] ZHANG Wei-feng;LI Feng;WANG Ming;GU Wei-ting;QIU Ji-ting;JIA Pi-feng;CHENG Kan;CAI Yu(Department of Neurosurgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 450000,China)

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海210000

出　　处：《中国临床神经外科杂志》2023年第4期252-254,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨高血压性脑出血开颅术后呼吸机辅助呼吸病人需要行气管切开的危险因素。方法回顾性分析2016年3月至2020年3月开颅手术治疗的123例高血压性脑出血的临床资料。术后均需要采用呼吸机辅助呼吸,术后2周不能脱机病人行气管切开。结果123例中,70例术后2周内顺利脱机,53例需行气管切开。多因素logistic回归分析后发现,入院GCS评分≤8分(OR=4.454;95%CI 1.236~16.048;P=0.022)、术前发生脑疝(OR=6.165;95%CI 1.950~19.493;P=0.002)、术前误吸(OR=3.025;95%CI 1.126~8.128;P=0.028)为术后需气管切开的独立危险因素。结论高血压性脑出血开颅术后呼吸机辅助呼吸病人中,入院GCS评分低、术前发生脑疝、误吸的病人,需要长时间进行呼吸机辅助呼吸,建议早期行气管切开。Objective To investigate the risk factors for tracheotomy in patients with hypertensive cerebral hemorrhage(HCH)undergoing ventilator-assisted breathing after craniotomy.Methods The clinical data of 123 patients with HCH who underwent craniotomy from March 2016 to March 2020 were retrospectively analyzed.All patients were required to use ventilators to assist breathing after surgery,and tracheotomy was performed in the patients who could not be come off a ventilator 2 weeks after surgery.Results Of 123 patients,70 patients were come off a ventilator successfully within 2 weeks after operation,and 53 patients needed tracheotomy.Multivariate logistic regression analysis showed that GCS score≤8 on admission(OR=4.454;95%CI 1.236~16.048;P=0.022),preoperative cerebral hernia(OR=6.165;95%CI 1.950~19.493;P=0.002),preoperative aspiration(OR=3.025;95%CI 1.126~8.128;P=0.028)were independent risk factors for postoperative tracheotomy.Conclusions Of patients with HCH undergoing ventilator assisted breathing after craniotomy,those with low GCS score on admission,cerebral hernia and aspiration before surgery need ventilator-assisted breathing for a long time,and early tracheotomy is recommended.

关 键 词：高血压性脑出血 开颅手术 呼吸机辅助呼吸 气管切开 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]