急性颈脊髓损伤患者气管切开时机的临床研究

摘要

Objective To study the optimal timing of tracheotomy in patients with acute cervical spinal cord injury who need ventilation for a long time . Methods A retrospective research on seventy-nine patients with acute cervical spinal cord injury who underwent tracheostomy in our hospital from January 2011 to December 2015 was conducted .The 79 patients were divided into two groups.The patients with a duration from intubation to tracheostomy less than or equal to 10 days were enrolled in group A , and the duration more than 10 days, group B.The duration of ventilation , the length of ICU stay , and the incidence rate of lung infection were compared between the two groups . Results The duration of ventilation in the group A (192 ±58) h was less than that in the group B (348 ±53) h (t=-12.490, P=0.000).The length of ICU stay in the group A (9.8 ±2.7) d was less than that in the group B (15.9 ±2.2) d (t=-11.058, P=0.000).The incidence of pneumonia in the group A (16.2%, 6/37) was lower than that in the group B (38.1%, 16/42,χ2 =4.686, P=0.030).Mechanical ventilation was successfully withdrawn in 34 and 38 cases of group A and B, without significant difference (χ2 =0.000, P=1.000). Conclusion Early tracheostomy in patients with acute cervical spinal cord injury who need ventilation for a long time could shorten the duration of ventilation and the length of ICU stay , and decrease the incidence of pneumonia .%目的探讨急性颈脊髓损伤需要长时间机械通气患者气管切开的最佳时机。方法回顾性分析2011年1月～2015年12月我科79例接受气管切开手术的急性颈脊髓损伤的临床资料。按气管切开距气管插管的时间将患者分为2组，甲组患者气管切开距气管插管≤10 d，乙组患者气管切开距气管插管＞10 d，比较2组患者机械通气时间、ICU住留时间、肺部感染发生率有无差异。结果甲组患者机械通气时间（192±58） h较乙组（348±53） h明显缩短（ t＝－12．490，P＝0.000）。甲组患者ICU时间（9．8±2．7）d明显短于乙组（15．9±2．2）d（t＝－11．058，P＝0．000）。甲组患者肺部感染发生率16．2％（6／37），明显低于乙组38．1％（16／42）（χ2＝4．686， P＝0.030）。2组成功撤离机械通气的例数分别为34、38例，无统计学差异（χ2＝0．000，P＝1．000）。结论对于短时间内不能撤离机械通气的急性颈脊髓损伤患者，早期气管切开可减少机械通气时间，缩短ICU住留时间，降低肺部感染发生率。