摘要
背景脑梗死常合并严重延髓麻痹,传统气管插管时机较迟,因长时间的延髓麻痹,导致治疗难度增大,预后变差。目的探讨早期气管插管联合镇痛镇静治疗脑梗死合并严重延髓麻痹的效果。方法选择2020年5月至2021年5月该院收治的脑梗死并发严重延髓麻痹患者70例,分为早期插管组(35例)和传统插管组(35例),插管后均予以丙泊酚,瑞芬太尼镇痛镇静。比较两组患者插管前及插管后的动脉血气分析指标;气管插管前病情危重程度及3个月时预后评价[美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、改良Rankin评分量表(mRS)评分、洼田饮水试验评分、急性缺血性脑卒中相关肺炎评分(AIS-APS)];全身并发症(肺部感染、消化道出血、急性心力衰竭、急性肾功能衰竭)的发生率;临床转归及预后:发病至插管时间,在ICU住院天数,长期无法拔管患者例数,可拔管患者插管至拔管天数。结果两组患者插管后的动脉血气分析指标均有好转(P<0.05)。与传统插管组比较,早期插管组能减少肺部感染、消化道出血、急性心力衰竭发生率(P<0.05);肾功能衰竭有减少趋势,但无统计学差异(P>0.05)。与传统插管组比较,早期插管组,发病至插管时间更短(P<0.05);在ICU住院天数更短(P<0.05)。长期无法拔管患者例数两组差异无统计学意义(P>0.05);而可拔管患者插管至拔管时间,早期插管组更短(P<0.05)。3个月时,早期插管组预后较传统插管组好(NIHSS评分、GCS评分、mRS评分、洼田饮水试验评分、AIS-APS评分),均P<0.05)。结论早期气管插管联合镇痛镇静能减轻病情严重程度,能减少全身并发症发生率,促进病情恢复,改善远期预后。
Background Cerebral infarction is often complicated with severe bulbar paralysis,and the late timing of traditional endotracheal intubation often results in long-term bulbar paralysis,thereby leading to the difficulties in treatment and poor prognosis.Objective To investigate the clinical effect of early endotracheal intubation combined with analgesia and sedation in the treatment of cerebral infarction with severe bulbar paralysis.Methods A total of 70 patients with cerebral infarction and severe bulbar paralysis who were admitted to our department from May 2020 to May 2021 were enrolled and divided into early intubation group and traditional intubation group,with 35 patients in each group,and all patients were given propofol and remifentanil for analgesia and sedation after intubation.The two groups were compared in terms of arterial blood gas parameters before and after intubation,disease severity before endotracheal intubation,prognostic evaluation at 3 months[National Institutes of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,modified Rankin Scale(mRS)score,water swallow test score,acute ischemic stroke-associated pneumonia score(AIS-APS)],the incidence rates of systemic complications(pulmonary infection,gastrointestinal bleeding,acute heart failure,and acute renal failure),and clinical outcome and prognosis(time from disease onset to intubation,length of stay in the intensive care unit(ICU),the number of patients unable to receive extubation for a long time,and the number of days from intubation to extubation for the patients who received extubation).Results Both groups had significant improvements in arterial blood gas parameters after intubation(P<0.05).Compared with the traditional intubation group,the early intubation group had significant reductions in the incidence rates of pulmonary infection,gastrointestinal bleeding,and acute heart failure(P<0.05)and a slight reduction in renal failure(P>0.05).Compared with the traditional intubation group,the early intubation group had significantly shorter time from disease onset to intubation(P<0.05)and length of stay in the ICU(P<0.05).There was no significant difference between the two groups in the number of patients who were unable to receive extubation for a long time(P>0.05),and as for the patients who received extubation,the early intubation group had a significantly shorter time from intubation to extubation than the traditional intubation group(P<0.05).Compared with the traditional intubation group at 3 months,the early intubation group had a significantly better prognosis based on NIHSS score,GCS score,mRS score,water swallow test score,and AIS-APS score(P<0.05).Conclusions Early endotracheal intubation combined with analgesia and sedation can alleviate the severity of the disease before intubation,reduce the incidence rates of systemic complications,promote the recovery of the disease,and improve long-term prognosis.
作者
刘芳
夏明万
李坚
石功亮
何勇
LIU Fang;XIA Ming-Wan;LI Jian;SHI Gong-Liang;HE Yong(Department of Comprehensive Internal Medicine,South District of the First People’s Hospital of Chenzhou,Chenzhou,Hu-nan 423000,China;Department of Neurology ICU,the First People’s Hospital of Chenzhou,Chenzhou,Hunan 423000,China;Emergency Department of the First People’s Hospital of Chenzhou,Chenzhou,Hunan 423000,China;Department of Pharmacy,the First People’s Hospital of Chenzhou,Chenzhou,Hunan 423000,China)
出处
《国际神经病学神经外科学杂志》
2022年第4期13-18,共6页
Journal of International Neurology and Neurosurgery
基金
湘南学院2021年度校级课题(2021XJ114)
郴州市科技局2021年度课题(lcyl2021001)。
关键词
脑梗死
早期气管插管
镇痛镇静
严重延髓麻痹
cerebral infarction
early endotracheal intubation
analgesia and sedation
severe bulbar paralysis