重症监护病房有创通气患者脓毒症休克与气管损伤的关系:一项单中心前瞻性队列研究  

Association between septic shock and tracheal injury in intensive care unit patients with invasive ventilation:a single-centre prospective cohort study

作　　者：张培[1] 杨其霖[2] 尹春华 蔡志刚[3] 卢怀海[1] 李海涛[3] 李立文 田叶 白龙 黄立宁[4] Zhang Pei;Yang Qilin;Yin Chunhua;Cai Zhigang;Lu Huaihai;Li Haitao;Li Liwen;Tian Ye;Bai Long;Huang Lining(Department of Anesthesiology and Intensive Care,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Critical Care,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Department of Respiratory Medicine,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Anesthesiology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院麻醉重症医学科,石家庄050000 [2]广州医科大学第二附属医院重症监护科,广州510260 [3]河北医科大学第二医院呼吸科,石家庄050000 [4]河北医科大学第二医院麻醉科,石家庄050000

出　　处：《中华麻醉学杂志》2024年第12期1505-1513,共9页Chinese Journal of Anesthesiology

基　　金：中国科学院-威高研究发展计划(2019-1)。

摘　　要：目的评价重症监护病房(ICU)有创通气患者脓毒症休克与气管损伤的关系。方法本研究为单中心前瞻性队列研究,选择2020年5月31日至2022年3月5日在河北医科大学第二医院麻醉重症医学科接受有创机械通气的患者。记录患者一般资料以及入住ICU病因、生命体征指标、实验室检验结果、急性生理和慢性健康评估Ⅱ评分、查尔森共病指数、气管插管型号、是否存在脓毒症休克、氧合指数、插管持续时间、去甲肾上腺素总用量、肾上腺素总用量及拔除气管导管时的气管损伤评分。采用单因素线性回归分析筛选出气管损伤的危险因素,采用多元线性回归分析进行校正。结果最终纳入97例患者,年龄(56.6±16.5)岁,男性比率64.9%。校正线性回归结果显示,脓毒症休克与气管损伤评分相关(β=2.99,95%CI 0.70~5.29)。亚组分析显示,插管持续时间≥8 d时,两者有较强相关性(P=0.013)。结论脓毒症休克患者气管损伤评分明显高于非脓毒症休克患者,提示脓毒症休克可能是气管损伤的独立危险因素。Objective To evaluate the association between septic shock and tracheal injury in the intensive care unit(ICU)patients with invasive ventilation.MethodsThis was a prospective single-centre cohort study.Patients who underwent invasive mechanical ventilation at the Department of Anesthesia Critical Care Medicine of the Second Hospital of Hebei Medical University from May 31,2020 to March 5,2022 were selected.The general characteristics of patients,reasons for ICU admission,vital signs,laboratory test results,Acute Physiology and Chronic Health EvaluationⅡscores,Charlson Comorbidity Index,size of endotracheal tube,presence or absence of septic shock,oxygenation index,duration of intubation,consumption of norepinephrine and epinephrine,and tracheal injury scores at the time of extubation were recorded.Univariate linear regression analysis was used to identify the risk factors for tracheal injury,followed by adjustment using multivariate linear regression analysis.ResultsNinety-seven patients were ultimately included,and the average age was(56.6±16.5)yr,with 64.9%being male.The results of adjusted linear regression showed that septic shock was associated with tracheal injury scores(β=2.99,95%confidence interval 0.70-5.29).Subgroup analysis revealed a stronger correlation with a duration of intubation≥8 days(P=0.013).ConclusionsPatients with septic shock exhibit significantly higher tracheal injury scores compared with those without septic shock,suggesting that septic shock may serve as an independent risk factor for tracheal injury.

关 键 词：休克 脓毒性 危重病人医疗 呼吸 人工 气管插管并发症 

分 类 号：R47[医药卫生—护理学]