气管切开神经重症患者堵管成功影响因素的回顾性研究

A standard tracheal decannulation procedure

目的判断肺功能各指标、气管套管内径、吞咽功能等预测因子在神经重症患者成功堵管中的价值,规范气管切开套管拔除流程。方法选择2018年11月至2020年3月我院康复医学科收治符合纳入标准的患者28例,堵管前评估患者肺功能、吞咽功能,记录痰量、气管套管内径,堵管后对结果进行回顾性分析。结果预测堵管成功与否的因子有用力肺活量(FVC)、用力肺活量百分比(FVC%)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积百分比(FEV1%)、最大呼气流量(PEF),其OR值均>1,上述指标值越高,堵管成功的可能性越大,其中FEV1和PEF对堵管的影响最大,其OR值分别为81.70和27.77。FEV1预测堵管成功的最佳截断值为0.42 L,此时敏感度为100%,特异度为63.64%,正确指数为0.636。结论FEV1可作为预测堵管是否成功的因子,提高拔管成功率。

Objective To determine the value of lung function,cannula diameter and swallowing function in predicting the success of tube blocking in patients with severe neurological diseases so as to standardize the tracheal decannulation procedure.Methods The tracheotomy tube blocking of 28 neurological disease patients was studied retrospectively.Before their tracheotomy tubes were blocked the patients′lung function and swallowing function had been evaluated,and sputum volume and endotracheal tube diameter had been recorded.Results The five most useful predictors of success in tracheotomy tube blocking were FVC,FVC%,FEV1(L),FEV1(L),FEV1(L)and PEF(L/S).Their OR values were all greater than 1,indicating good predictive power.FEV1 and PEF showed the best predictive power,with OR values of 81.70 and 27.77,respectively.There was no significant difference between the two groups in terms of the other indicators.FEV1 predicted that the best truncation value for tracheotomy tube blocking success is 0.42L,achieving a sensitivity was 100%a specificity of 63.64%,and a correction index of 0.636.Conclusion FEV1 values can be a useful predictor of successful tracheotomy tube blocking.Using it should improve the success rate of tube decannulation.