获得性脑损伤患者成功拔除气管套管的预测因素研究

Study on predictors of successful decannulation in patients with acquired brain injury

目的分析影响获得性脑损伤(ABI)患者拔除气管套管的相关因素并评估各独立因素对ABI患者成功拔管的联合预测价值。方法回顾性分析自2017年1月至2021年10月合肥市第八人民医院收治的145例行气管切开术的ABI患者的临床资料。按照是否成功拔管分为拔管组(100例)和未拔管组(45例)。采用单因素、多因素Logistic回归分析筛选出影响拔管结果的独立因素,并用受试者工作特性(ROC)曲线分析评估其联合预测价值。结果单因素分析显示:2组患者在意识水平(GCS评分)、肺部感染情况、吞咽功能、咳嗽反射、自愿咳嗽、吸痰次数/8 h及堵管耐受性(堵管≥48 h)方面比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:肺部感染(95%CI:0.071~0.813,P=0.022),吸痰次数/8 h(95%CI:0.045~0.451,P=0.001)及咳嗽反射(95%CI:1.785~27.718,P=0.005)是拔管结果的独立影响因素,其联合预测模型ROC曲线下面积为0.924(95%CI:0.880~0.969),最佳截断值为0.646,敏感度为84.4%,特异度为90%。结论肺部感染情况、吸痰次数/8 h及咳嗽反射对ABI患者成功拔管具有较高的预测价值。

Objective To explore related factors affecting the results of decannulation in patients with acquired brain injury(ABI),and to evaluate the combined predictive value of independent factors for successful decannulation in patients with ABI.Methods A retrospective study was conducted on clinical data of 145 ABI patients who underwent tracheotomy admitted to the Eighth People's Hospital of Hefei from January 2017 to October 2021.According to the success of decannulation,the group was divided into the decannulation group(n=100)and the undecannulation group(n=45).Independent factors influencing decannulation results were screened by univariate and multivariate Logistic regression analysis,and their combined predictive value was evaluated by receiver operating characteristic(ROC)curve analysis.Results Univariate analysis showed that there were statistically significant differences between the two groups in consciousness level(GCS score),pulmonary infection control,swallowing function,cough reflex,voluntary cough,sputum aspiration times/8 h and tube blockage tolerance(tube blockage≥48 h)(P<0.05).Multivariate Logistic regression analysis showed pulmonary infection(95%CI:0.071-0.813,P=0.022),sputum aspiration times/8 h(95%CI:0.045-0.451,P=0.001)and cough reflex(95%CI:1.785-27.718,P=0.005)was an independent risk factor affecting extubation results,and the area under ROC curve of its combined prediction model was 0.924(95%CI:0.880-0.969),the optimal cut-off value was 0.646,the sensitivity was 84.4%,and the specificity was 90%.Conclusion Pulmonary infection,sputum aspiration times/8 h and cough reflex have high predictive value for successful decannulation in ABI patients.