留置不同人工气道长期机械通气患者原因、并发症及预后的探讨

摘要

目的 探讨留置不同人工气道长期机械通气患者的病因和并发症的差异性.方法 分析南充市中心医院重症医学科A区2014年2月～2016年2月长期机械通气的300例呼吸衰竭患者临床资料,依据留置人工气道不同进行分组,经鼻气管插管组150例和气管切开组150例.观察两组呼吸衰竭患者一般资料、基础疾病、并发症、长期机械通气的原因、拔管率、死亡率及生存时间的情况.结果 两组呼吸衰竭患者性别、年龄、呼吸衰竭类型、急性生理与慢性健康(APACHEⅡ)评分、高血压、冠心病、糖尿病、吸人性肺炎、前列腺增生、肿瘤发生率、COPD、重症肺炎、间质性肺疾病、神经肌肉疾病、脑血管意外、心血管疾病、多器官功能衰竭发生率、气管软化、气管食管瘘、气管狭窄、气管内出血、套管堵塞发生率差异无统计学意义(P＞0.05),经鼻气管插管组呼吸衰竭患者COPD发生率高于气管切开组(P＜0.05),脑梗死发生率低于气管切开组(P＜0.05),经鼻气管插管组呼吸衰竭患者衰竭患者吸人性肺炎(VAP)、感染性鼻窦炎发生率高于气管切开组(P＜0.05),经鼻气管插管组呼吸衰竭患者拔管率、死亡率及生存时间均低于气管切开组(P＜0.05).结论 肺部疾病是长期机械通气主要原因,VAP、感染性鼻窦炎是主要并发症,选择好人工气道方式,可以减少并发症发生,延长生存时间,降低死亡率.%Objective To approach otherness application of pathogenesis and complication for long-term mechanical ventilation patients by indwelling different artificial airway.Methods 300 patients with respiratory failure for long-term mechanical ventilation in the Area A,ICU,Nanchong Central Hospital from February 2014 to February 2016 were analyzed and divided into two groups by indwelling different artificial airway,nasal trachea cannula group (150 cases) and tracheotomy group (150 cases).The general information,underlying disease,complication,cause of long-term mechanical ventilation,tube drawing rate,death rate and survival time of two groups were detected.Results The sex,age,respiratory failure style,APACHE Ⅱ scores,hypertension,coronary heart disease,diabetes mellitus,VAP,BPH,tumour rate,COPD,severe pneumonia,interstitial lung disease,neuromuscular disease,stroke,angiocardiopathy,multiple organ failure rate,tracheomalacia,tracheoesophageal fistula,tracheostenosis,trachea hemorrhage,casing plugging rate of two groups had no difference (P ＞ 0.05).The rate of COPD in the nasal trachea cannula group was higher than that in the tracheotomy group (P ＜ 0.05),the rate of cerebral infarction in the nasal trachea cannula group was lower than that in the tracheotomy group (P ＜ 0.05),the rate of VAP and nosocomial sinusitis in the nasal trachea cannula group were higher than those in the tracheotomy group (P ＜ 0.05),the tube drawing rate,death rate and survival time of nasal trachea cannula group were lower than those of tracheotomy group (P ＜ 0.05).Conclusion The pulmonary disease is a primary cause of long-term mechanical ventilation,VAP and nosocomial sinusitis are major complication.A good artificial airway way can decrease complications,extension survival time and decrease death rate.