预防性气管切开术对长期卧床老年病人吸入性肺炎发生率及病死率的影响

摘要

目的 观察床旁预防性经皮扩张气管切开术(protective percutaneous dilation tracheotomy,PPDT)对长期卧床老年病人吸入性肺炎发生率及其病死率的影响. 方法 采用开放对照前瞻性研究方法,选择168例长期卧床行PPDT(PPDT组)的老年病人,同时选择174例病因基本相同,长期卧床非气管切开老年病人为对照(对照组),比较短期、长期吸入性肺炎发生率与病死率的差异. 结果 PPDT组短期、长期吸入性肺炎月均发生率显著低于对照组(32.1％比93.1％ P≤0.001;24.4％比78.1％ P≤0.001).PPDT组短期、长期病死率分别为7.7％、9.6％,对照组分别为20.6％、25.3％,2组比较差异均有统计学意义(P均≤0.05). 结论 PPDT能有效减少长期卧床老年病人吸入性肺炎的发生,降低其死亡风险.%Objective To observe the influences of bedside protective percutaneous dilation tracheotomy(PPDT) on morbidity of aspiration pneumonia and mortality in the long-term bed elderly patients.Methods An open control prospective study was carried out.168 long-term bed elderly patients received bedside PPDT (PPDT group).The morbidity of aspiration pneumonia and the mortality of the patients after PPDT for short term(one month)and long term (one year)were observed.The clinical data of 174 patients who did not receive PPDT (control group) were also analyzed.Results The short-term and long-term morbidity rate of aspiration pneumonia in PPDT group were significantly lower than those in control group (32.1％ vs 93.1％,24.4％ vs 78.1％ P≤0.001),as well as the mortality (7.7％ vs 20.6％P=0.010;9.6％ vs 23.5％ P=0.014).Conclusions The bedside PPDT could effectively prevent aspiration pneumonia and decrease the risk of death in the long-term bed elderly patients.