GCS评分、咳嗽效力评级与颅脑疾病气管切开术后拔管成功的关系

Relationship between GCS Score,Cough Efficacy Rating and Success of Extubation after Tracheotomy in Craniocerebral Diseases

目的 探讨格拉斯哥昏迷量表(GCS)、咳嗽效力评级与颅脑疾病气管切开术后拔管成功的关系。方法 选取2019年8月—2022年8月收治的颅脑疾病96例,均行气管切开插管术,按照拔管成功与否分为观察组(拔管成功)58例和对照组(拔管失败)38例。比较2组吞咽功能、GCS评分以及咳嗽效力评级,采用多因素Logistic回归分析探讨颅脑疾病气管切开术后拔管成功的危险因素。结果 观察组有吞咽反射患者占比、GCS评分13~14分患者占比高于对照组,无吞咽反射患者占比、GCS评分3~8分及<3分患者占比低于对照组(P<0.05)。观察组咳嗽效力评级0级患者占比低于对照组,5级患者占比高于对照组(P<0.05)。吞咽反射、GCS评分及咳嗽效力评级是影响颅脑疾病气管切开术后拔管成功的独立危险因素(P<0.01)。结论 GCS评分及咳嗽效力评级是影响颅脑疾病气管切开术后拔管成功的独立危险因素,可重点关注并加以干预,以提高颅脑疾病气管切开术后拔管成功率。

Objective To explore the relationship between Glasgow Coma Scale(GCS),cough efficacy rating and extubation success after tracheotomy for craniocerebral diseases.Methods A total of 96 patients with craniocerebral diseases treated from August 2019 to August 2022 were selected,all of whom underwent tracheotomy intubation,and were divided into observation group(successful extubation,n=58) and control group(unsuccessful extubation,n=38),according to successful or unsuccessful extubation.The swallowing function,GCS score and cough efficacy rating of the two groups were compared.Multivariate Logistic regression analysis was used to explore the risk factors affecting the success of extubation after tracheotomy for craniocerebral diseases.Results The proportion of patients with swallowing reflex and GCS score 13-14 in observation group was higher than that in control group,while the proportion of patients without swallowing reflex,GCS score 3-8 and <3 was lower than that in control group(P<0.05).The proportion of patients with cough efficacy rating of 0 in observation group was lower than that in control group,and the proportion of patients with cough efficacy rating of 5 was higher than that in control group(P<0.05).Swallowing reflex,GCS score and cough efficacy rating were independent risk factors for successful extubation after tracheotomy(P<0.01).Conclusion GCS score and cough efficacy rating are independent risk factors affecting the success of extubation after tracheotomy for craniocerebral diseases.Clinical attention should be paid to these evaluation indicators and intervention should be made to improve the success rate of extubation after tracheotomy for craniocerebral diseases.