重型急性脑卒中患者气管套管拔出困难因素分析

Analysis of difficult factors of tracheal cannula decannulation in patients with severe acute stroke

目的分析影响脑卒中后气管切开患者气管套管拔管困难的因素。方法回顾性分析2013年3月至2018年11月北京市回民医院收治的重型急性脑卒中、发病30 d内气管切开并气管套管植入的患者62例。依据是否拔管分为拔管组(n=27)与未拔管组(n=35)。比较两组患者一般资料、临床资料、美国国立卫生研究院卒中量表(NIHSS)评分、并发症、气管切开相关资料等,并通过多因素Logistic回归分析对相关因素进行分析。采用改良Rankin量表(m RS)评分评价患者气管切开后3、6及12个月的结果。结果拔管组的气管切开时NIHSS评分、机械通气时间、急性加重的慢性心力衰竭(AECHF)发生率均低于未拔管组,差异有统计学意义(均P<0.05);多因素Logistic回归分析显示,NIHSS评分、机械通气时间、AECHF是能否拔出气管套管的独立影响因素(均P<0.05);拔管组3、6、12个月的m RS评分均好于未拔管组(均P<0.05)。结论气管切开时NIHSS评分、机械通气时间、AECHF是重型急性脑卒中气管切开术后能否拔管的独立影响因素,拔管组患者的功能预后好于未拔管组。

Objective To analyze the difficult factors impacting tracheal cannula decannulation in patients with severe acute stroke after tracheotomy.Methods A total of 62 patients with severe acute stroke admitted to the Beijing Moslem People’s Hospital and underwent tracheotomy combined with tracheal cannula implantation within 30 days after onset from March 2013 to November 2018 were analyzed retrospectively.According to whether decannulation was performed or not,they were divided into the decannulation group(n=27)and the non-decannulation group(n=35).The general data,clinical data,National Institutes of Health Stroke Scale(NIHSS)scores,complications and tracheotomy related data of the two groups of patients were compared,and the related factors were analyzed by multivariate Logistic regression analysis.The results of 3 months,6 months and 12 months in patients after tracheotomy were evaluated by modified Rankin scale(mRS).Results The NIHSS score at tracheotomy,mechanical ventilation time and the incidence of acute exacerbation of chronic heart failure(AECHF)in the decannulation group were lower than those in the non-decannulation group,with statistically significant difference(all P<0.05).Multivariate Logistic regression analysis showed that NIHSS score,mechanical ventilation time and AECHF were independent factors impacting whether the decannulation was performed(all P<0.05).MRS scores of the decannulation group after 3 months,6 months and 12 months were all better than those of the nondecannulation group(all P<0.05).Conclusion NIHSS score at tracheotomy,mechanical ventilation time and AECHF are independent impacting factors of decannulation after tracheotomy in patients with severe acute stroke.The functional prognosis of patients in the decannulation group is better than that in the non-decannulation group.