摘要
目的探讨脑梗死患者气管切开时机及其预后的影响因素。方法回顾性选取2015年9月至2022年9月萍乡市人民医院重症医学科收治的59例脑梗死患者为研究对象,根据气管切开时间将其分为早期组(n=35,机械通气7 d内实施气管切开)和晚期组(n=24,机械通气7 d后实施气管切开),比较两组患者格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分、机械通气时长、气管切开持续时间及并发症发生率。根据脑梗死后气管切开患者28 d内的预后情况,进一步分为预后良好组和预后不良组,采用多因素logistic分析影响脑梗死患者气管切开预后的独立危险因素。结果早期组患者机械通气时长、ICU住院时间、抗生素使用时间均短于晚期组,差异有统计学意义(P<0.05);预后良好组患者年龄、基线NIHSS评分均低于预后不良组,GCS评分高于预后不良组,气管切开时间短于预后不良组,差异有统计学意义(P<0.05);多因素logistic回归分析显示,年龄>70岁(β=0.684,OR=1.982,95%CI=1.193~3.292)、基线NIHSS评分(β=0.694,OR=2.002,95%CI=1.125~3.562)、气管切开时间(β=0.794,OR=2.212,95%CI=1.179~4.150)是影响脑梗死气管切开患者预后不良的独立危险因素(P<0.05)。结论脑梗死患者早期气管切开可有效缩短机械通气时长、ICU住院时间、抗生素使用时间;年龄>70岁、基线NIHSS评分、气管切开时间是导致脑梗死患者不良预后的独立危险因素,对高龄及NIHSS评分异常患者应严密监护,并及早实施气管切开,对改善患者临床预后具有重要作用。
Objective To investigate the timing of tracheotomy and the prognostic factors in patients with cerebral infarction.Methods A total of 59 patients with cerebral infarction admitted to the First Department of Intensive Care Unit of Pingxiang People's Hospital from September 2015 to September 2022 were selected retrospectively as research objects,and they were divided into the early group(n=35,tracheotomy was performed within 7 d of mechanical ventilation)and late group(n=24,tracheostomy was performed after 7 d of mechanical ventilation)according to the time of tracheotomy tracheostomy.The Glasgow coma scale(GCS),National Institutes of Health stroke scale(NIHSS)score,duration of mechanical ventilation,duration of tracheostomy and incidence of complications were compared between the two groups.According to the prognosis of patients with tracheotomy within 28 d after cerebral infarction,they were further divided into good prognosis group and poor prognosis group.Multivariate logistic analysis was used to analyze the independent risk factors affecting the prognosis of tracheotomy.Results The duration of mechanical ventilation,ICU hospitalization and antibiotic use in the early group were shorter than those in the late group,the differences were statistically significant(P<0.05).The age and baseline NIHSS score of patients in the good prognosis group were lower than those in the poor prognosis group,GCS score was higher than that in the poor prognosis group,and tracheotomy time was shorter than that in the poor prognosis group,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that age>70 years old(β=0.684,OR=1.982,95%CI=1.193-3.292),baseline NIHSS score(β=0.694,OR=2.002,95%CI=1.125-3.562)and tracheotomy time(β=0.794,OR=2.212,95%CI=1.179-4.150)were independent risk factors for poor prognosis of patients with cerebral infarction undergoing tracheotomy(P<0.05).Conclusion Early tracheotomy can effectively shorten the duration of mechanical ventilation,ICU hospitalization and antibiotic use in patients with cerebral infarction.Age>70 years old,baseline NIHSS score and tracheotomy time were independent risk factors for poor prognosis in patients with cerebral infarction.The elderly and patients with abnormal NIHSS score should be closely monitored and tracheotomy should be performed as early as possible,it plays an important role in improving the clinical prognosis of patients.
作者
漆柳
贺婷
郑晓东
QI Liu;HE Ting;ZHENG Xiaodong(The First Department of Intensive Care Unit,Pingxiang People's Hospital,Jiangxi Province,Pingxiang,337055,China)
出处
《中国当代医药》
CAS
2023年第24期57-60,65,共5页
China Modern Medicine
基金
江西省卫生计生委科技计划项目(20171436)。
关键词
脑梗死
气管切开
时机
预后
影响因素
Cerebral infarction
Tracheotomy
Timing
Prognosis
Influencing factors
