临床和实验医学杂志
臨床和實驗醫學雜誌
림상화실험의학잡지
JOURNAL OF CLINICAL AND EXPERIMENTAL MEDICINE
2014年
12期
976-979
,共4页
神经危重症%气管切开%拔管%影响因素
神經危重癥%氣管切開%拔管%影響因素
신경위중증%기관절개%발관%영향인소
Eurological intensive care unit%Tracheotomy%Extubation%Influence factor
目的：探讨影响神经危重症气管切开患者拔除气管插管成功率的相关因素。方法回顾性分析2004年1月至2013年10月神经科重症监护病房（NICU）收治的223例神经危重症并气管切开患者。按拔管是否成功分为两组。比较两组患者拔除气管切开插管时的基本临床资料、重要脏器功能、格拉斯哥昏迷量表（GCS）评分、呼吸参数、肺部感染控制情况、营养状况、咳嗽反射、插管时间以及有无进行堵管试验之间的差异。结果223例气管切开患者拔管成功198例，拔管失败25例。单因素分析显示，高龄、重要脏器功能不全、中重度贫血、低蛋白血症、呼吸过快、咳嗽反射差共6个危险因素与拔管失败有显著相关（ P 均﹤0.01）。多因素 Logistic 回归分析显示，重要脏器功能不全、中重度贫血、低蛋白血症、咳嗽反射差与拔管失败较为密切，其中咳嗽反射差相对危险度最大，是预测拔管失败最重要的危险因素。结论重要脏器功能不全、中重度贫血、低蛋白血症、咳嗽反射差对于预测神经危重症患者气管切开拔管能否成功存在意义，而患者的年龄、原发病性质、意识障碍程度呼吸参数、插管时间对于预测拔管能否成功暂无明确意义。拔管时除重视肺部感染控制外，还要重视患者的全身情况、营养状况、呼吸功能储备，特别是咳嗽是否有力。
目的：探討影響神經危重癥氣管切開患者拔除氣管插管成功率的相關因素。方法迴顧性分析2004年1月至2013年10月神經科重癥鑑護病房（NICU）收治的223例神經危重癥併氣管切開患者。按拔管是否成功分為兩組。比較兩組患者拔除氣管切開插管時的基本臨床資料、重要髒器功能、格拉斯哥昏迷量錶（GCS）評分、呼吸參數、肺部感染控製情況、營養狀況、咳嗽反射、插管時間以及有無進行堵管試驗之間的差異。結果223例氣管切開患者拔管成功198例，拔管失敗25例。單因素分析顯示，高齡、重要髒器功能不全、中重度貧血、低蛋白血癥、呼吸過快、咳嗽反射差共6箇危險因素與拔管失敗有顯著相關（ P 均﹤0.01）。多因素 Logistic 迴歸分析顯示，重要髒器功能不全、中重度貧血、低蛋白血癥、咳嗽反射差與拔管失敗較為密切，其中咳嗽反射差相對危險度最大，是預測拔管失敗最重要的危險因素。結論重要髒器功能不全、中重度貧血、低蛋白血癥、咳嗽反射差對于預測神經危重癥患者氣管切開拔管能否成功存在意義，而患者的年齡、原髮病性質、意識障礙程度呼吸參數、插管時間對于預測拔管能否成功暫無明確意義。拔管時除重視肺部感染控製外，還要重視患者的全身情況、營養狀況、呼吸功能儲備，特彆是咳嗽是否有力。
목적：탐토영향신경위중증기관절개환자발제기관삽관성공솔적상관인소。방법회고성분석2004년1월지2013년10월신경과중증감호병방（NICU）수치적223례신경위중증병기관절개환자。안발관시부성공분위량조。비교량조환자발제기관절개삽관시적기본림상자료、중요장기공능、격랍사가혼미량표（GCS）평분、호흡삼수、폐부감염공제정황、영양상황、해수반사、삽관시간이급유무진행도관시험지간적차이。결과223례기관절개환자발관성공198례，발관실패25례。단인소분석현시，고령、중요장기공능불전、중중도빈혈、저단백혈증、호흡과쾌、해수반사차공6개위험인소여발관실패유현저상관（ P 균﹤0.01）。다인소 Logistic 회귀분석현시，중요장기공능불전、중중도빈혈、저단백혈증、해수반사차여발관실패교위밀절，기중해수반사차상대위험도최대，시예측발관실패최중요적위험인소。결론중요장기공능불전、중중도빈혈、저단백혈증、해수반사차대우예측신경위중증환자기관절개발관능부성공존재의의，이환자적년령、원발병성질、의식장애정도호흡삼수、삽관시간대우예측발관능부성공잠무명학의의。발관시제중시폐부감염공제외，환요중시환자적전신정황、영양상황、호흡공능저비，특별시해수시부유력。
Objective To study the relevant factors of extubation success rate to neurological critically patients with tracheotomy. Meth-ods A retrospective analysis in January 2004 to October 2013 in our hospital neurology intensive care unit(NICU)was performed in 223 cases of critically neurological patients with tracheotomy. All these patients were divided into two groups according to the success of extubation. Two groups were compared with the basic clinical data when tracheostomy tube removal. The clinical data included vital organ function,glasgow Coma Scale (GCS)score,respiratory parameters,lung infection control situation,nutritional status,cough reflex,and the presence or absence of intubation time between tests plugging differences. Results Successful extubation was observed in 198 of 223 cases with tracheotomy,while 25 cases show-ing extubation failure. Univariate analysis showed that six risk factors,including age,major organ dysfunction,severe anemia,hypoproteinemia, rapid breathing,poor cough reflex associated with extubation failure( P ﹤ 0. 01). Logistic regression analysis showed significant organ dysfunc-tion,severe anemia,hypoalbuminemia,poor cough reflex were more closely associated with extubation failure. Among all these factors,poor cough reflex is the greatest relative risk factor. Conclusion Vital organ dysfunction,severe anemia,hypoalbuminemia,poor cough reflex in critically patients can predict extubation success in tracheotomy patients. The patient′s age,the nature of the primary disease,the degree of consciousness breathing parameters,intubation time in predicting extubation success rate did not show difference. In addition to emphasis on extubation lung in-fection control,the patient′s general condition,nutritional status,respiratory functional reserve,especially with heavy cough should be paid atten-tion.
