重症脑血管病患者早期气管切开的临床价值

目的  探讨重症脑血管病患者早期气管切开的临床价值。方法 回顾性分析102例重症脑血管病患者。所有患者入院48 h内进行了气管插管，气管插管后5 d内进行了气管切开者55例（早期气管切开组）；气管插管5 d后进行了气管切开者47例（延迟气管切开组）。比较两组间病死率、镇静药物的用量、院内获得性肺炎（HAP）的发生率、机械通气的时间、ICU住院时间等指标。结果 早期气管切开组机械通气的时间、ICU住院时间、抗生素使用天数和镇静剂的用量均低于延迟气管切开组，差异有统计学意义（177±94）h vs（266±162）h，P=0.03；（10±5）d vs（13±4）d，P=0.006；（9±4）d vs（12±4）d，P=0.03；（139±39）mg vs（186±48）mg，P=0.001）]。两组病死率和HAP的发生率差异无统计学意义（29.1% vs 36.2%，P=0.45；49.1% vs 63.8%，P=0.13）。结论 重症脑血管病患者早期气管切开可获得较大的收益，提倡早期气管切开以改善预后。

Applying Early Tracheotomy in Severe Stroke Patients

Objective To assess the applying of tracheotomy in early stage in severe stroke patients.Methods We investigated 102 stoke patients who underwent endotracheal intubation in 48 hours after admission retrospectively. All the patients were divided into two groups, early tracheotomy group (n=55) who underwent tracheotomy within 5 days after endotracheal intubation, and delayed tracheotomy group (n=47) who underwent tracheotomy after 5 days. We compared the mortality, dosage of sedative, incidence of hospital acquired pneumonia(HAP), duration of mechanical ventilation and hospitalization in intensive care unit(ICU) of the two groups.Results Early tracheotomy could reduce the duration of mechanical ventilation(178±94 h vs 266±162 h, P=0.03) and hospitalization in ICU(10±5 d vs 13±5 d, P=0.006), and it could also reduce the duration of antibiotic(19±4 d vs 12±4 d, P=0.03) and the dosage of sedative significantly(138.72±38.77 mg vs 186±48 mg, P=0.001). However there was no significant difference in mortality (29.1% vs 36.2%, P=0.45) and incidence of HAP(49.1% vs 63.8%, P=0.13) between the early tracheotomy group and delayed tracheotomy group.Conclusion Severe stroke patients can get some benefit from early tracheotomy.