颈胸部CT联合纤维喉镜检测指标对ABI后气管切开患者拔管的指导价值研究

Value of cervicothoracic CT combined with fiberoptic laryngoscopy in guiding decannulation in patients with tracheostomy after acquired brain injury

目的研究颈胸部CT联合纤维喉镜检测指标对获得性脑损伤(ABI)后气管切开患者拔管成功的指导价值。方法采用回顾性分析,选取2020年1月年至2023年5月期间在安徽医科大学第一附属医院康复的ABI后气管切开患者35例作为研究对象。患者均行颈胸部CT联合纤维喉镜检查,分析上气道通畅性、肺部感染及纤维喉镜评估指标对拔管成功与否的影响。结果拔管成功率为68.57%(24/35)。根据拔管情况将受试者分为拔管组(n=24)及未拔管组(n=11)。拔管组的气管切开时间为153(125,284)d,而未拔管组为411(359,791)d,差异有统计学意义(P<0.05)。拔管组气道狭窄率为20.83%(5/24),未拔管组气道狭窄率为36.36%(4/11),差异有统计学学意义(χ^(2)=8.26,P<0.05)。拔管组反复感染率为4.17(1/24),未拔管组为36.36%(4/11),差异有统计学意义(P<0.05)。拔管组咽喉部水肿发生率25.00%(6/24)低于未拔管组的36.36%(4/11),声带活动异常率12.50%(3/24)低于未拔管组的36.36%(4/11),差异有统计学意义(P<0.05)。结论气道狭窄、肺部感染、咽喉部水肿、声带活动异常发生率对ABI后气管切开患者拔管成功具有指导价值。

Objective To study the guiding value of cervicothoracic CT combined with fiberoptic laryngoscopy for the successful decannulation in the patients with tracheostomy after acquired brain injury(ABI).Methods A retrospective analysis was adopted.Thirty-five rehabilitation patients with tracheostomy due to ABI in the First Affiliated Hospital of Anhui Medical University from January 2020 to May 2023 were selected as the study subjects.The patients all performed the cervical and thoracic CT combined with fiberoptic laryngoscopic examination.The effects of upper airway patency,pulmonary infection and fibrolaryngoscopy evaluation indexes on the success of decannulation were analyzed.Results The success rate of decannulation was 68.57%.The subjects were divided into the decannulation group(n=24)and non-decannulation group(n=11)according to the decannulation situation.The tracheostomy time was 153(125,284)d in the decannulation group and 411(359,791)d in the non-decannulation group,and the difference between the two groups was statistically significant(P<0.05).The airway stenosis rate in the decannulation group was 20.83%(5/24),which in the non-decannulation group was 36.36%(4/11),and the difference was statistically significant(χ^(2)=8.26,P<0.05).The incidence rate of recurrent infection in the decannulation group was 4.17(1/24),which in the non-decannulation group was 36.36%(4/11),and the difference was statistically significant(P<0.05).The incidence rate of laryngeal edema in the decannulation group was 25.00%(6/24),which was lower than 36.36%in the non-decannulation group,the abnormal rate of vocal cord activity in the decannulation group was 12.50%(3/24),which was lower than 36.36%(4/11)in the non-decannulation group,and the difference was statistically significant(P<0.05).Conclusion The airway stenosis,pulmonary infection,laryngeal edema and incidence rate of abnormal vocal cord activity have the guiding value in the successful decannulation of the patients with tracheostomy after ABI.