早期经皮气管切开对重型脑血管意外患者的影响

目的:评估早期经皮气管切开(percutaneous dilational tracheotomy,PDT)对重型脑血管意外患者的影响。方法:对我院2007年5月至2012年12月采用PDT行气管切开的87例重型脑血管意外患者进行回顾性分析。根据经口插管机械通气(mechanical ventilation,MV)时间将患者分成早期气管切开组(≤7d Early tracheotomy,ET)共42例,晚期气管切开组(7 d Late tracheotomy,LT)共45例,其中ET组男性23例,平均年龄41.36±14.12岁,LT组男性26例,平均年龄46.38±13.87岁。观察两组患者的一般情况、经口插管MV时间、PDT后MV时间、PDT后住重症医学科(intensive care unit,ICU)时间、总住院时间、28d病死率和呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率等。结果:两组患者在一般情况如年龄、性别、急性生理学和慢性健康状况(Acute physiology and chronic health evaluation II,APACHEII)评分以及格拉斯哥昏迷(Glasgow coma scale,GCS)评分比较,差异均无统计学意义(P均0.05),ET组显著缩短了经口插管MV时间、PDT后MV时间、PDT后住ICU时间,差异均有统计学意义(P均0.05),但两组在总住院时间、28d病死率和VAP发生率比较,差异均无统计学意义(P均0.05)。结论:虽然ET不影响患者预后及VAP发生率,但可缩短患者经口插管MV时间、PDT后MV时间、PDT后住ICU时间,故对于重型脑血管意外患者应采取早期PDT。

Effect of Early Percutaneous Dilational Tracheotomy in Patient with Severe Cerebrovascular Accident

Objective： To examine the impact of early percutaneous dilational tracheotomy （PDT） in patient with severe cerebrovascular accident. Methods： A total of 87 patients with severe cerebrovascular accident underwent PDT from May 2007 to December 2012, were retrospectively studied. According to the length of endotracheal intubation with mechanical ventilation （MV）, the patients will be divided into two groups： early tracheotomy group （≤ 7d Early tracheotomy, ET） of 42 cases, and late tracheotomy group （〉7 d Late tracheotomy, LT） of 45 cases. The general of the two groups of patients, endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay, the length of stay in hospital, 28d mortality and the incidence of ventilator-associated pneumonia （VAP） were compared between the two groups. Results： No differences were found in general, such as age, gender, Acute physiology and chronic health evaluation II （APACHEII） score and Glasgow coma scale （GCS） score between the two groups （all P 〉 0.05）. Endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay were significant shorter in the ET group （P 〈0.05）. But the length of stay in hospital, 28d mortality and the incidence of VAP showed no different between the two groups （P 〉 0.05）. Conclusion： Although ET does not shorten the length of stay in hospital, 28d mortality and the incidence of VAP, it may shorten endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay, so early percutaneous dilational tracheotomy should be adopted in patient with severe cerebrovascular accident.