CAJ | 학술논문

目的研究影响神经危重症患者拔除气管插管成功率的相关因素.方法本研究为回顾性、描述性研究.纳入2008年12月至2011年2月,南方医院神经内科重症监护病房收治的40名因中枢神经系统疾病需行气管插管,且插管时间大于6h的患者.排除了资料不完整,及治疗无效或脑死亡或个别拔除气管插管后立即行气管切开的患者.按拔管是否成功分为两组.比较两组患者拔除气管插管前的基本临床资料、呼吸参数、24 h出入量、痰液情况、格拉斯哥昏迷评分(GCS)及四分法评分(Four Scale)之间的差异,采用SPSS 13.0统计软件分析处理数据.结果 GCS评分及Four评分在拔管成功及拔管失败两组患者中差异具有统计学意义(P均＜0.05),且在评估拔管结果时效能差异具有统计学意义(P=0.012),并与插管结果存在显著相关性(P=0.041),发生癫痫在两组间差异亦有统计学意义.而其他因素对于预测拔管能否成功暂无统计学意义.结论本研究表明,GCS评分及Four评分对于预测神经危重症患者拔管能否成功存在意义,而患者的人口学数据及常用呼吸参数及痰液性状、痰液量、24 h出入量等在传统拔管指征基础上的分级研究对于预测拔管能否成功暂无明确意义.而其他因素对NICU患者,能否起到预测拔管失败的作用,尚需要更多前瞻性、随机对照研究的进行.
목적 연구영향신경위중증환자발제기관삽관성공솔적상관인소.방법 본연구위회고성、묘술성연구.납입2008년12월지2011년2월,남방의원신경내과중증감호병방수치적40명인중추신경계통질병수행기관삽관,차삽관시간대우6h적환자.배제료자료불완정,급치료무효혹뇌사망혹개별발제기관삽관후립즉행기관절개적환자.안발관시부성공분위량조.비교량조환자발제기관삽관전적기본림상자료、호흡삼수、24 h출입량、담액정황、격랍사가혼미평분(GCS)급사분법평분(Four Scale)지간적차이,채용SPSS 13.0통계연건분석처리수거.결과 GCS평분급Four평분재발관성공급발관실패량조환자중차이구유통계학의의(P균＜0.05),차재평고발관결과시효능차이구유통계학의의(P=0.012),병여삽관결과존재현저상관성(P=0.041),발생전간재량조간차이역유통계학의의.이기타인소대우예측발관능부성공잠무통계학의의.결론 본연구표명,GCS평분급Four평분대우예측신경위중증환자발관능부성공존재의의,이환자적인구학수거급상용호흡삼수급담액성상、담액량、24 h출입량등재전통발관지정기출상적분급연구대우예측발관능부성공잠무명학의의.이기타인소대NICU환자,능부기도예측발관실패적작용,상수요경다전첨성、수궤대조연구적진행.
Objective To Explored the relative factors which caused the extubation failure in neurological intensive care unit (NICU).Methods It was a retrospective study.40 cases of patients who met the criteria,were brought into statistical analysis.They were admitted in NICU in Nan Fang Hospital from December 2008 to February 2011.The name,sex,age,diagnosis,respiratory parameters,24 hours discrepancy quantity,sputum,and Glasgow Coma Scale,Full Outline of UnResponsiveness Scale were recorded.SPSS 13.0 was used as statistic software.P ＜ 0.05 was considered statistically significant.Results Both in extubation successful and failure groups,GCS and Four were significantly different (all P ＜ 0.05).Howerer,there were no statistically significant in the other factors.There were significantly differences between GCS and Four in predicting extubation results (P =0.012).Logistic multiple regression showed that Four and GCS grade were predictive factor of extubation failure (P =0.041).Conclusions The result suggests that it is statistically significant to use GCS and Four as factors to predict extubation results.It can be widely used to help medical personnels monitoring the changes of patients'clinical conditions,judging prognosis,and making treatment plan in NICU.Wether other factors would effect the extubation results,more prospective,randomized controlled studies were needed.