脑卒中肺部感染患者气管切开时机对预后的影响

Impact of timing of tracheotomy on prognosis of stroke patients with pulmonary infections

目的探讨脑卒中肺部感染患者气管切开时机对预后的影响,以降低肺部感染率。方法回顾性分析2009-2012年ICU脑卒中肺部感染经皮气管切开的患者60例,按手术时间分成早期气管切开(观察组)和延迟气管切开(对照组),每组各30例,比较两组患者病死率和肺部感染好转率、GCS评分、SIRS持续时间、CPIS评分、机械通气时间、ICU住院时间和气管切开手术并发症发生率差异。结果经皮气管切开均成功,观察组肺部感染好转率为56.67%,高于对照组的30.00%(P<0.05),两组病死率差异无统计学意义;观察组患者SIRS持续时间、CPIS评分、机械通气时间、ICU住院时间均短于对照组(P<0.05),并发症发生率及病死率观察组分别为23.33%、16.67%,低于对照组的30.00%、20.00%,但差异无统计学意义。结论早期气管切开可以明显缩短机械通气时间和ICU住院时间,临床医师需综合判断病情,根据GCS评分、CPIS评分、机械通气时间等个体化选择气管切开时间。

OBJECTIVE To explore the influence of timing of tracheotomy on prognosis of the stroke patients with pulmonary infections so as to reduce the incidence of pulmonary infections.METHODS A total of 60stroke patients with pulmonary infections who underwent the percutaneous tracheotomy in ICU from 2009to 2012were retrospectively reviewed,then the patients were divided into the early tracheotomy group（the observation group）and the delayed tracheotomy group（the control group）according to the time of surgery,with 30cases in each;the mortality rate,improvement rate of pulmonary infections,GCS score,SIRS duration,mechanical ventilation duration,length of ICU stay,and incidence of complications were observed and compared between the two groups.RESULTS All the percutaneous tracheotomies were successful,the improvement rate of pulmonary infections was 56.67%in the observation group,higher than 30.00%in the control group（P〈0.05）;the difference in the mortality rate between the two groups was not significant.The SIRS duration,CPIS score,mechanical ventilation duration,and length of ICU stay were shorter in the observation group than in the control group（P〈0.05）.The incidence of complications was 23.33%in the observation group,lower than 30.00%in the control group;the mortality rate was 16.67%in the observation group,lower than 20.00%in the control group,but the difference was not significant.CONCLUSIONThe early tracheotomy can significantly shorten both the mechanical ventilation duration and the length of ICU stay.It is necessary for the clinicians to comprehensively consider the illness condition and choose appropriate time for tracheotomy according to the GCS score,GPIS score,and mechanical ventilation duration.