摘要
目的研究创伤性颈脊髓损伤患者的气管切开时机及临床预后。方法回顾性分析2008年1月1日至2021年12月31日在丽水市中医院收治的单节段创伤性颈脊髓损伤合并呼吸功能不全且接受气管切开治疗的患者65例。根据从气管插管到初次气管切开的时间将患者分为早期组(从插管到气管切开≤7d,n=31)和晚期组(从插管到气管切开>7d,n=34),比较两组患者机械通气时间、拔管时间和重症监护病房(intensive care unit,ICU)住院时间等指标。结果早期组患者机械通气时间(23.9±16.5)d,较晚期组(37.3±25.7)d明显缩短(t=−10.310,P=0.025);早期组患者ICU住院时间(19.7±5.5)d,明显短于晚期组(26.8±12.4)d(t=−9.058,P=0.021);早期组患者拔管时间(51.0±27.1)d,明显短于晚期组(73.1±46.8)d(t=−10.039,P=0.021),差异均有统计学意义(P<0.05)。两组患者的肺部感染发生率、病死率及90d再住院率比较,差异无统计学意义(P>0.05)。结论对于短时间不能脱离机械通气的急性创伤性颈脊髓损伤患者,在插管后7d内进行气管切开,可减少机械通气和ICU住院时间,改善患者的预后且不增加并发症发生率。
Objective To study the timing and clinical prognosis of tracheotomy in patients with traumatic cervical spinal cord injury.Methods A total of 79 patients with acute cervical spinal cord injury who underwent tracheotomy in Lishui Hospital of Traditional Chinese Medicine from January 2011 to December 2015 were retrospectively analyzed.Patients were divided into two groups according to the time from tracheal intubation to initial tracheotomy:early group(≤7 days from intubation to tracheotomy,n=31),late group(>7 days from intubation to tracheotomy,n=34),mechanical ventilation time,extubation time and intensive care unit(ICU)stay time were compared between the two groups.Results The mechanical ventilation time in the early group(23.9±16.5)d was significantly shorter than that in the late group(37.3±25.7)d(t=−10.310,P=0.025);the ICU length of stay in the early group(19.7±5.5)days was significantly shorter than that in the late group(26.8±12.4)days(t=−9.058,P=0.021).The extubation time in the early group(51.0±27.1)days was significantly shorter than that in the late group(73.1±46.8)days(t=−10.039,P=0.021),all difference were statistically significant(P<0.05).The prevalence of pulmonary infection,mortality,and 90-day readmission rate did not differ between the two groups.Conclusion In patients with acute traumatic cervical spinal cord injury who cannot be extubated for a short period of time,tracheotomy within 7 days after intubation reduces mechanical ventilation and ICU length of stay,improves patient outcomes,without increasing complication rates.
作者
罗俊祥
王富麟
江丽平
LUO Junxiang;WANG Fulin;JIANG Liping(Department of Critical Care Medicine,Lishui Hospital of Traditional Chinese Medicine,Zhejiang,Lishui 323000,China;Department of Emergency Medicine,People’s Liberation Army Joint Logistics Support Force 903 Hospital,Hangzhou 310013,China)
出处
《中国现代医生》
2022年第26期47-50,54,共5页
China Modern Doctor
关键词
气管插管
气管切开时机
机械通气
创伤性颈脊髓损伤
Tracheal intubation
Timing of tracheostomy
Mechanical ventilation
Traumatic cervical spinal cord injury
