ICU中行经皮扩张气管切开术后套管移除困难的临床特点分析

Analysis of the clinical characteristics associated with challenging tracheal tube removal following percutaneous dilatational tracheostomy in ICU

目的探讨综合重症监护病房(ICU)中急危重症患者经皮扩张气管切开术(PDT)后成功移除气管切开(气切)套管的相关影响因素,为提高套管成功移除率提供理论依据。方法选取2014年1月至2022年5月在西安市第九医院综合ICU治疗期间因不同病因需行气管切开术(特指实施了PDT)患者144例,按是否成功移除气切套管分为移除组(70例)和未移除组(74例)。收集2组患者基线资料包括性别、年龄、吸烟史、原发病等,以及气切套管移除相关资料包括堵管前意识水平、咳痰能力、分泌物量、气切套管留置时间、机械通气时间、并发症、堵管试验等。建立多因素logistic回归模型探讨移除气切套管的影响因素。结果144例患者平均年龄(60.7±14.3)岁,男104例(72.2%),移除气切套管成功率为48.6%(70/144)。咳痰能力、分泌物量、堵管试验是成功移除气切套管的独立影响因素(优势比=10.964、6.173、56.475,95%可信区间1.960~61.316、1.263~30.170、10.992~290.159)。结论综合ICU中急危重症患者行PDT后咳嗽能力、分泌物量、堵管试验是影响气切套管移除的风险因素。

Objective To investigate the influencing factors associated with successful decannulation of percutaneous dilatational tracheostomy(PDT)in the intensive care unit(ICU),and provide theoretical basis for improving the successful removal rate of cannula.Methods A total of 144 patients who needed tracheotomy(especially PDT)for different reasons during the treatment in the comprehensive ICU of the Ninth Hospital of Xi'an from January 2014 to May 2022 were divided into two groups according to whether the tracheotomy cannula was successfully removed:the removal group(70 cases)and the non-removal group(74 cases).Baseline data of patients in the two groups were collected,including gender,age,smoking history,primary disease,etc.,and related data of gas cutting cannula removal included consciousness level before tube plugging,expectoration ability,secretion volume,indwelling time of gas cutting cannula,mechanical ventilation time,complications,tube plugging test,etc.A multi-factor logistic regression model was established to explore the influencing factors of gas cutting casing removal.Results The average age of 144 patients was(60.7±14.3)years,with a majority of 104 males(72.2%).The success rate for tracheostomy tube removal was determined to be 48.6%(70/144).Multivariate analysis revealed that coughing ability(OR=10.964,95%CI 1.960-61.316),secretion volume(OR=6.173,95%CI 1.263-30.170),and tube occlusion experiment(OR=56.475,95%CI 10.992-290.159)were identified as independent factors influencing successful tracheostomy tube removal.Conclusion The cough capacity,secretion volume and tube blocking test of acute and critically ill patients after percutaneous dilatation tracheotomy in comprehensive ICU are risk factors affecting the removal of gas resection cannula.