重症脑卒中早期开放人工气道的临床价值评价研究

Clinical Value of Early Opened Artificial Airway in Severe Stroke Patients

目的探讨重症脑卒中患者早期施行人工气道的临床价值。方法选择2005年1月—2009年9月入住我院的重症脑卒中患者,格拉斯哥评分(GCS)<9分。按人工气道开放时间不同分为治疗组(78例)和对照组(73例),治疗组除给予脑卒中常规处理外,入院后即予人工气道建立,包括气管插管、气管切开,视呼吸情况必要时予呼吸支持;对照组常规治疗同治疗组,但入院后没有立即给予开放人工气道,出现明显呼吸功能障碍后才给予气管插管或气管切开,视病情必要时予呼吸支持。比较两组患者出院时死亡率、肺部感染情况和误吸发生率,同时比较两组病例住院时间和住院总费用。观察入院第1、3、5、7天时两组患者的平均心率、呼吸频率、PaO2、PaCO2和血WBC计数的变化。结果对照组延迟性人工气道开放46例,平均入院后(45.60±15.04)h开放。两组患者死亡率、肺部感染率比较差异无统计学意义(P>0.05),但肺部感染发生时间治疗组迟于对照组,差异有统计学意义(P<0.01),治疗组误吸发生率、住院时间和住院费用与对照组比较,差异均有统计学意义(P<0.05)。入院后第1、3、5、7天治疗组平均心率较对照组低,差异有统计学意义(P<0.01);入院第1、3天治疗组呼吸频率较对照组慢,PaO2较对照组高,差异有统计学意义(P<0.01),第5、7天则无明显统计学差异(P>0.05);PaCO2水平第1、3、5天治疗组低于对照组,差异有统计学意义(P<0.01),第7天两组相近;血WBC计数比较,第1、7天两组无明显改变,第3、5天治疗组低于对照组,差异有统计学意义(P<0.01)。结论重症脑卒中早期开放人工气道能提高血氧含量,降低机体呼吸功耗,延缓肺部感染发生时间,并能缩短住院时间,降低医疗费用,但不能降低死亡率,值得早期急救推广应用。

Objective To investigate the clinical value of artificial airway early conducted for patients with severe stroke.Methods All the inpatients with severe stroke in our hospital from January 2005 to September 2009 had Glasgow Coma Scale（GCS）9.They were divided as trial group（n=78） and control group（n=73） based on different open time of artificial airway.Besides the conventional therapy of stroke,for the patients in the trial group artificial airway was established immediately including endotracheal intubation and tracheotomy after admission,ventilation is given if needed.The same conventional therapy was given for the patients in the control group,no artificial airway was conducted immediately after admission,only when respiratory dysfunction occurred,and ventilation is given if necessary.The mortality,the rates of lung infection and incidence of aspiration between the two groups were compared,and the total cost and duration of hospitalization were also compared when discharged.The average heart rate,respiratory rate,the value of PaO2,PaCO2 and the WBC count of the patients in both groups at the 1st,3rd,5th,7th day after being hospitalized were observed.Results There were 46 patients in the control group who underwent delayed artificial airway,and the average airway open time was（45.60±15.04） hours.There was no significant difference between the two groups in mortality and incidence of lung infection（P0.05）.However the lung infection occurred later in the trial group than that in the control group（P0.05）.And the incidence of aspiration was lower,duration of hospitalization was shorter and the hospitalization cost was lower in the trial group than in the control group（P0.01）.The average heart rate at the 1st,3rd,5th,7th day after admission was lower in trial group than in the control group（P0.01）.As compared with the control group,the respiratory rate was lower and the PaO2 was higher in the trial group at the 1st,3rd day（P0.01）,but no significant difference was found at the 5th,7th day（P0.05）.The PaCO2 was lower in the trial group at the 1st,3rd,5th day（P0.01）,but it gets similar with that in the control group at the7th day.No significant difference in WBC was found between two groups at the 1st,7th day,but the WBC count at the 3rd,5th day was significantly lower in the trial group than in the control group（P0.01）.Conclusion In severe stroke patients,early opened artificial airway can raise the blood oxygen content,reduce the respiratory energy consumption,delay pulmonary infection,shorten duration of hospitalization,and lower medical costs.But it can not reduce the mortality.It is worthy of popularizing in early first-aid.