不同气管切开时机对重症脑血管病患者预后的影响  

The effect of different timing of tracheotomy on the prognosis of patients with severe cerebrovascular disease

作　　者：陈志鹏 陈荣城 CHEN Zhipeng;CHEN Rongcheng(Intensive Care Unit,Department of Interventional Neurology,Zhangzhou Municipal Hospital of Fujian Province,Fujian,Zhangzhou 363000,China;Department of Interventional Neurology,Zhangzhou Municipal Hospital of Fujian Province,Fujian,Zhangzhou 363000,China)

机构地区：[1]福建省漳州市医院神内介入科重症监护室,福建漳州363000 [2]福建省漳州市医院神内介入科,福建漳州363000

出　　处：《中国医药科学》2025年第4期94-97,138,共5页China Medicine And Pharmacy

基　　金：福建省漳州市医院博士工作室攀登项目(PDB202321)。

摘　　要：目的探讨不同气管切开时机对重症脑血管病患者预后的影响。方法回顾性纳入2022年1月至2023年3月福建省漳州市医院神内介入重症监护室(ICU)行气管切开的重症脑血管病患者68例作为研究对象,所有纳入病例住院期间均未死亡,以气管插管后行气管切开时间为标准分为早期切开组和晚期切开组。两组患者入院后均给予对症治疗,早期切开组:入院后3 d内实施气管切开术;晚期切开组:入院3 d及3 d后实施气管切开术。比较两组总住院时间、ICU住院时间、急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷(GCS)评分、美国国立卫生院卒中量表(NIHSS)评分和并发症发生率。结果早期切开组ICU住院时间、总住院时间、呼吸机相关性肺炎发生率、抗生素使用时间、镇痛镇静药物使用时间和并发症的发生率均明显少于晚期切开组,差异有统计学意义(P<0.05);干预前后,两组APACHEⅡ评分、GCS评分、NIHSS评分比较,差异无统计学意义(P>0.05)。结论对于重症脑血管病患者而言,早期气管切开可减少ICU住院时间、抗生素使用时间、镇痛镇静类药物使用时间,降低患者预后并发症的发病率。Objective To investigate the effect of different timing of tracheotomy on the prognosis of patients with severe cerebrovascular disease.Methods A total of 68 patients with severe cerebrovascular disease who underwent tracheotomy in the Intensive Care Unit(ICU)of the Department of Interventional Neurology at Zhangzhou Municipal Hospital of Fujian Province from January 2022 to March 2023 were retrospectively included as study subjects.All the included cases did not die during the hospitalization period,and were divided into the following groups based on the time of tracheotomy after tracheal intubation:the early tracheotomy group and the late tracheotomy group.Patients in both groups were given symptomatic treatment after admission.In the early tracheotomy group,tracheotomy was performed within 3 days of admission.In the late tracheotomy group,tracheotomy was performed at 3 days or after 3 days of admission.The total length of stay,length of stay in ICU,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,Glasgow coma(GCS)score,National Institutes of Health stroke scale(NIHSS)score,and incidence of complications were compared between the two groups.Results The length of stay in ICU,total length of stay,incidence of ventilator-associated pneumonia,duration of antibiotic use,duration of analgesic and sedative medication use,and incidence of complications were significantly lower in the early tracheotomy group than those in the late tracheotomy group,with statistically significant differences(P<0.05).Before and after the intervention,there was no statistically significant difference in the comparisons of the APACHEⅡscores,GCS scores,and NIHSS scores between the two groups(P>0.05).Conclusion For patients with severe cerebrovascular disease,early tracheotomy can reduce the length of stay in ICU,duration of antibiotic use and duration of analgesic and sedative medication use,thereby decreasing the incidence of prognostic complications in patients.

关 键 词：气管切开时机 重症脑血管病 神经功能 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]