神经危重症患者计划性气管插管拔管失败相关因素分析  

Analysis of factors related to planned extubation failure of tracheal intubation in neurocritical patient

作　　者：马祥 王奎 雍海荣[1] 凌张宾 张伟[1] 曹挺 MA Xiang;WANG Kui;YONG Hairong;LING Zhangbin;ZHANG Wei;CAO Ting(Department of Emergency,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院急诊大厅,安徽芜湖241001

出　　处：《沈阳医学院学报》2023年第6期602-606,643,共6页Journal of Shenyang Medical College

摘　　要：目的:分析神经危重症患者计划性气管插管拔管失败的相关因素,提高气管插管撤机拔管成功率。方法:选取我院神经外科重症监护室2022年1月至7月收治的82例气管插管使用呼吸机的患者,根据拔管结局分为拔管成功组(64例)和拔管失败组(18例),采用Logistic回归分析影响拔管结局的相关因素。结果:2组患者在序贯器官衰竭评分(SOFA)、漏气试验、咳痰能力、拔管前B型钠尿肽(BNP)、膈肌活动度(DE)、膈肌增厚分数(DTF)、肌力、吸烟、呼吸机相关性肺炎(VAP)、拔管前机械通气时间等方面比较差异均有统计学意义(P<0.05),Logistic回归分析显示DTF、吸烟、漏气试验阳性是影响拔管失败的相关因素。结论:膈肌功能受损、漏气试验阳性、吸烟是神经危重症患者气管插管拔管失败的危险因素,对于此类患者在撤机拔管过程中医护人员要做到多维度的评估。Objective:To analyze the related factors of planned extubation failure of tracheal intubation in neurocritical patients,in order to improve the success rate of extubation.Methods:From Jan 2022 to Jul 2022,a total of 82 patients with tracheal intubation using a ventilator admitted to the Intensive Care Unit of the Neurosurgery Department,Yijishan Hospital of Wannan Medical College,were selected.According the extubation outcome,patients were divided into the successful group(64 cases)and the failed group(18 cases).Logistic regression analysis was used to analyze the related factors of extubation failure.Results:There were statistically significant differences between the two groups in SOFA score,air leakage test,expectoration ability,BNP before extubation,diaphragmatic activity(DE),diaphragmatic thickening fraction(DTF),muscle strength,smoking,ventilator-associated pneumonia(VAP),mechanical ventilation time before extubation(P<0.05).Logistic regression analysis showed that DTF,smoking,and positive air leakage test were risk factors for extubation failure.Conclusions:Impaired diaphragm function,positive air leakage test and smoking are risk factors for extubation failure in neurocritical patients.For such patients,medical staff should make multi-dimensional evaluations during extubation.

关 键 词：神经危重症 气管插管 拔管失败 

分 类 号：R473.74[医药卫生—护理学]