中国急救医学
中國急救醫學
중국급구의학
Chinese Journal of Critical Care Medicine
2015年
9期
832-835,836
,共5页
陈晓梅%韩辉%董世笑%杜滨锋
陳曉梅%韓輝%董世笑%杜濱鋒
진효매%한휘%동세소%두빈봉
气管切开%重症监护病房%机械通气%预后
氣管切開%重癥鑑護病房%機械通氣%預後
기관절개%중증감호병방%궤계통기%예후
Tracheostomy%Intensive care unit%Mechanical ventilation%Outcomes
目的：验证早期气管切开与危重患者预后之间的关系。方法回顾性队列研究2010－01～2013－12未经选择的需要长期机械通气≥48 h危重患者。依据气管切开时机的频数分布分为早期组（ early tracheostomy ， ET）是机械通气≤5 d时进行气管切开的患者和晚期组（ late tracheostomy ， LT）是机械通气＞5 d时气管切开的患者。两组进行人口学、病因学和ICU死亡率的比较。数据源于电子病历。结果860例进行机械通气的患者中共有234例（27．21％）患者暴露于气管切开并纳入分析。其中早期组159例，晚期组75例。两组间病情严重程度没有差别，从年龄上，老年患者多接受晚期气管切开（P＜0．01），从病因构成上，颅脑外伤和中枢神经疾病患者多接受早期气管切开（ P＜0．01）。 ICU出院时气管套管带管率两组间相似。 ICU全因死亡率分别为早期组20．09％和晚期组11．97％（P＝0．2344）。早期组和晚期组ICU住院时间中位数分别是29 d和33 d（P＝0．015），机械通气时间的中位数分别是14．97 d和20．69 d（P＝0．013）。结论5 d内进行气管切开的患者与病情改善无关，但能缩短机械通气时间和ICU住院时间。
目的：驗證早期氣管切開與危重患者預後之間的關繫。方法迴顧性隊列研究2010－01～2013－12未經選擇的需要長期機械通氣≥48 h危重患者。依據氣管切開時機的頻數分佈分為早期組（ early tracheostomy ， ET）是機械通氣≤5 d時進行氣管切開的患者和晚期組（ late tracheostomy ， LT）是機械通氣＞5 d時氣管切開的患者。兩組進行人口學、病因學和ICU死亡率的比較。數據源于電子病歷。結果860例進行機械通氣的患者中共有234例（27．21％）患者暴露于氣管切開併納入分析。其中早期組159例，晚期組75例。兩組間病情嚴重程度沒有差彆，從年齡上，老年患者多接受晚期氣管切開（P＜0．01），從病因構成上，顱腦外傷和中樞神經疾病患者多接受早期氣管切開（ P＜0．01）。 ICU齣院時氣管套管帶管率兩組間相似。 ICU全因死亡率分彆為早期組20．09％和晚期組11．97％（P＝0．2344）。早期組和晚期組ICU住院時間中位數分彆是29 d和33 d（P＝0．015），機械通氣時間的中位數分彆是14．97 d和20．69 d（P＝0．013）。結論5 d內進行氣管切開的患者與病情改善無關，但能縮短機械通氣時間和ICU住院時間。
목적：험증조기기관절개여위중환자예후지간적관계。방법회고성대렬연구2010－01～2013－12미경선택적수요장기궤계통기≥48 h위중환자。의거기관절개시궤적빈수분포분위조기조（ early tracheostomy ， ET）시궤계통기≤5 d시진행기관절개적환자화만기조（ late tracheostomy ， LT）시궤계통기＞5 d시기관절개적환자。량조진행인구학、병인학화ICU사망솔적비교。수거원우전자병력。결과860례진행궤계통기적환자중공유234례（27．21％）환자폭로우기관절개병납입분석。기중조기조159례，만기조75례。량조간병정엄중정도몰유차별，종년령상，노년환자다접수만기기관절개（P＜0．01），종병인구성상，로뇌외상화중추신경질병환자다접수조기기관절개（ P＜0．01）。 ICU출원시기관투관대관솔량조간상사。 ICU전인사망솔분별위조기조20．09％화만기조11．97％（P＝0．2344）。조기조화만기조ICU주원시간중위수분별시29 d화33 d（P＝0．015），궤계통기시간적중위수분별시14．97 d화20．69 d（P＝0．013）。결론5 d내진행기관절개적환자여병정개선무관，단능축단궤계통기시간화ICU주원시간。
Objective Tracheostomy is a common clinical practice in ICU , but less research was focused on the relationship between the timing of tracheostomy and outcome of severe ill patients in China.This study aims to examine the association between early tracheostomy and mortality in ICU from China.Methods This retrospective observational cohort study was performed at a tertiary -care, university – affiliated hospital .Unselected patients requiring mechanical ventilation for ≥48 hours enrolled from January 2010 to December 2013 .According to the frequency distribution were classified. Early tracheostomy( ET) is considered if the procedure occurred≤5 days after mechanical ventilation and tracheostomy was considered late ( LT ) if the procedure occurred >5 days after mechanical ventilation.Data were collected from electronic medical record by senior physicians .Results Of the 860 mechanical ventilation patients screened , 234 (27.21%) received a tracheostomy , and 159 patients received the tracheostomy in early group and 75 patients received of patients ’ illness between the two groups.No significant difference in illness severity were between two groups .Older patients less likely received early tracheostomy (P<0.01) while patients with brain injury or central neurological disease more likely received early tracheostomy (P<0.01).The decannulated rate on discharge was similar between two groups .All -cause mortality at ICU discharge was no significantly different between 20.09%in early group and 11.97% in late group (P=0.2344).Median critical care unit length of stay was decreased for 29 days in early group while 33 days in late group ( P =0.015).Median mechanical ventilation period was shorter in early group for 14.97 days than in late group for 20.69 days (P=0.013).Conclusion Tracheosotmy within 5 days of critical care admission is not associated with an improvement at ICU discharge , but may benefit from shorter mechanical ventilation period and associated LOS in ICU .
