气管切开时机对神经重症机械通气患者预后的影响分析  

Analysis on the effect of timing of tracheotomy on the prognosis in patients with severe neurological condition undergoing mechanical ventilation

作　　者：王奎 范晓莉 陶秀彬 王楚楚 黄进 邵雪非 WANG Kui;FAN Xiaoli;TAO Xiubin;WANG Chuchu;HUANG Jin;SHAO Xuefei(Department of Neurology,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院神经内科ICU,安徽芜湖241001 [2]皖南医学院第一附属医院弋矶山医院护理部,安徽芜湖241001 [3]皖南医学院第一附属医院弋矶山医院神经外科,安徽芜湖241001

出　　处：《皖南医学院学报》2023年第6期528-532,共5页Journal of Wannan Medical College

基　　金：安徽省高等学校科学研究项目(2022AH040178);弋矶山医院科技创新团队“攀峰”培育计划项目(PF2019014)。

摘　　要：目的:探讨气管切开时机对神经重症机械通气患者的预后影响。方法:回顾性选择2020年1月~2021年12月入住弋矶山医院神经外科重症监护病房(NSICU)进行有创机械通气且行经皮气管切开(PDT)的患者274例,按照从气管插管到气管切开的时间分为早期气管切开组(≤3 d)和晚期气管切开组(>3 d)。观察两组患者一般基础资料、呼吸机相关性肺炎(VAP)发生率、颅内感染发生率、深静脉血栓(DVT)发生率、镇痛镇静时间、6个月格拉斯哥预后评分(GOS)、NSICU住院时间、总住院时间、总机械通气时间、NSICU病死率、住院病死率、28 d及90 d病死率。结果:早期气管切开组诊断为急重型颅脑损伤占比高于晚期组,诊断为颅内动脉瘤占比低于晚期组(P<0.05);入院双侧瞳孔光反应灵敏占比低于晚期组,光反应消失占比高于晚期组(P<0.05);入院GCS评分低于晚期组(P<0.05);入院时急性生理与APACHEⅡ评分高于晚期组(P<0.05);早期组VAP发生率、镇痛镇静时间、总机械通气时间、NSICU住院时间低于晚期组(P<0.05);两组在总住院时间、病死率及6个月GOS评分方面差异均无统计学意义(P>0.05)。结论:早期气管切开可以降低神经重症机械通气患者VAP的发生率,缩短镇痛镇静时间、缩短机械通气时间及NSICU住院时间,能够改善患者部分临床预后,值得在临床实践中积极实施。Objective:To investigate the effect of timing of tracheotomy on the prognosis in patients with severe neurological condition undergoing mechanical ventilation.Methods:A total of 274 patients undergone invasive mechanical ventilation and percutaneous tracheotomy(PDT)in the Neurosurgery Intensive Care Unit(NSICU)of our hospital were included from January 2020 to December 2021,and divided into early tracheal incision group(≤3 days)and late tracheal incision group(>3 days)according to the time from tracheal intubation to tracheal incision.Then the two groups were observed regarding the general basic data of patients,incidences of ventilators associated pneumonia(VAP),intracranial infection and deep vein thrombosis(DVT)as well as duration of analgesia and sedation,Glasgow prognostic score at 6 months(GOS),length of stay in NSICU,total length of hospital stay,total time of mechanical ventilation,case fatality rate in NSICU and in hospital,and the fatality rate at day 28 and 90.Results:The proportion of severe craniocerebral injury in early tracheotomy group was higher than that in late group,and the proportion of intracranial aneurysm was lower than that in late group(P<0.05).The proportion of sensitive photoresponsive pupils at admission was lower in early tracheal incision group than in late tracheal incision group,yet disappearance of photoresponsive pupils was in early tracheal incision group than in late tracheal incision group(P<0.05).The GCS scoring at admission was lower in early tracheal incision group than in late tracheal incision group,whereas the APACHEⅡscoring at admission was higher in the early tracheal incision group(P<0.05).Patients in the early tracheal incision group had lower incidence of VAP,shorter analgesic and sedative time,shorter total mechanical ventilation time and hospital stay of NSICU than those in the late tracheal incision group(P<0.05).There were no significant differences in total hospital stay,case fatality rate and GOS scoring at 6-month between the two groups(P>0.05).Conclusio

关 键 词：气管切开 神经重症 机械通气 预后 

分 类 号：R741[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]