老年人超长期留置气管插管80例分析

Analysis of 80 ultra long-term endotracheal intubations in the elderly

目的研究老年患者超长期留置气管插管的预后及相关因素。方法回顾分析解放军总医院2004年6月—2008年6月214例气管插管患者病历资料,其中,男204例,女10例,年龄68～105(85.39±5.45)岁,以插管时间30d为界分为超长期组80例和常规组134例,两组性别、年龄、插管时呼吸衰竭类型和急性生理学及慢性健康状态评分等方面均无统计学差异。对两组气管导管相关性肺炎、并发症、拔管率、气管切开率进行统计学分析,同时分析超长期留置气管导管的原因。结果与常规组比较,超长期组气管切开率显著高(35.00%vs20.90%,P<0.05)、病死率显著低(43.75%vs61.94%,P<0.05)。两组气管导管相关性肺炎发生频次[(0.78±0.14)次/(月·例)vs(0.81±0.25)次/(月·例)]、并发症发生率(2.50%vs3.73%)、拔管率(21.25%vs17.16%)、气管切开后生存时间[(350.75±39.88)dvs(468.92±316.42)d]等方面差异无统计学意义。80例长期置管原因:长期病情不稳定,不能行气管切开12例(15.00%);对导管耐受良好,病情好转,预期可拔管26例(32.50%);拒绝气管切开31例(38.75%);原因不清11例(13.75%)。结论老年气管插管患者行气管切开的时机应个体化,不应受时间限制。在良好的医护条件下,适当地推迟气管切开的时机具有可行性,并能使老年患者受益,对一些特殊情况也可长期留置气管导管。

Objective To investigate the prognosis and the causes of the ultra long-term endotracheal intubations in the elderly. Methods Retrospectively,214 old patients hospitalized in General Hospital of PLA were divided by 30 days of endotracheal intubation time into two groups：the uhra long-term group （UTG,80 cases）and routine group （RG, 134 cases）. Intubation related pneumonia, eomplication,extubation rate and tracheotomy rate were investigated. The causes of the ultra long-term endotracheal intu- bation were analyzed and the 3 special cases were reported. Results The mean age of 214 patients,including 204 male patients and 10 females,was 85.39±5.45 years old. The tracheotomy rate of UTG was remarkably higher than RG（35.00% vs 20.90%,P=0.02） and the mortality of UTG was lower than RG （43.75% vs 61.94%,P=0.01）. There was no significant difference between 2 groups in the frequency of intubation related pneumonia, （0.78±0.14）/（month.ease） vs （0.81±0.25）/（month-case）,P=0.33;eomplication,2.50% vs 3.73%,P=0.93;extubation rate 21.25% vs 17.16%,P=0.46; and the total survival time（350.75±39.88）d vs （468.92±316.24）d,P=0.15. The causes of 80 cases ultra long-term endotracheal intubations mainly included： 12 tracheotomy＇s was not performed for unstable physical condition,26 tracheotomy＇s was delayed for improvement of physical condition, 31 tracheotomy＇s was not permitted by patients or their relatives. Conclusions It＇s not necessary to set time limitation of tracheotomy at the intubated elderly patients. In better medical care condition,it＇s beneficial to delay tracheotomy reasonably. In specific condition, long-time intubation was acceptable.