脑卒中患者行气管切开术后影响其预后的相关因素分析

The Analysis of Related Elements About the Stroke Outcome with Tracheostomy

目的对脑卒中患者行气管切开术后影响其预后的可能因素进行分析。方法对入住本院神经内科重症病房的27例行气管切开术的脑卒中患者的临床资料进行回顾性分析,对所有患者的卒中类型(分脑梗塞和脑出血)、病变部位(分幕上和幕下)、肢体瘫痪累及范围情况(分单侧和双侧)、年龄(分70岁以下和70岁以上)、术前格拉斯哥评分(GCS)等可能影响预后的因素进行单因素分析;追踪并记录患者术后3个月的预后改良的Rankin评分(mRS)。结果脑出血与脑梗塞组患者的mRS比较,差异无统计学意义(P>0.05);幕上病变患者的mRS低于幕下病变组(P<0.05);双侧肢体瘫痪组与单侧肢体瘫痪组患者的mRS比较,差异无显著性(P>0.05);70岁以下年龄组的mRS明显低于70岁以上组(P<0.01);GCS小于8分组的mRS与GCS大于8分组的mRS存在显著性差异(P<0.05)。结论需行气管切开术的脑卒中患者总体预后较差,卒中类型及肢体瘫痪累及范围情况对预后无影响,幕下病变、高龄,低GCS的患者预后更差,医务人员需根据患者的一般情况谨慎选择气管切开术。

Objective To explore the relationship between the stroke outcome with tracheostomy and age,Glasgow Coma Scale（ GCS）,the stroke＇s type. Methods Retrospectively review 27 patients with stroke who received tracheostomy. The stroke＇s age,cerebral hemorrhage or infarction,infratentorial lesions or supratentorial lesions,diplegia or hemiparalysis were recorded,we also signed the GCS before tracheostomy and the modified scale Rankin（ mRS） after three months.Results There were no difference between cerebral hemorrhage or infarction. The mRS of infratentorial lesions were higer than those in supratentorial lesions（ P 0. 05）. The stroke＇s mRS had no difference between diplegia and hemiparalysis（ P 0. 05）. The mRS of patients,whose age was over 70 was significantly higer than that of younger（ P 0. 01）. The mRS of patients whose GCS was more than 8 was significantly lower than that of lower（ P 0. 05）. Conclusions The stroke who needs tracheostomy has a poor outcome normally,Cerebral hemorrhage or infarction,diplegia or hemiparalysis are not related to the outcome. The patients who are older,infratentorial lesions,lower GCS have a worse outcome. We should be cautious to choose the tracheostomy and consider more about the patients＇ condition.