神经重症患者气管切开的预测因素分析

雷铃; 吴朝文; 陈万; 罗先海

doi:10.13201/j.issn.1009-5918.2022.02.014

神经重症患者气管切开的预测因素分析

- 成都市新都区人民医院重症医学科(成都，610500)
基金项目:
四川省卫生和计划生育委员会科研课题(No: 17PJ145)

详细信息

通讯作者: 罗先海，E-mail：1423440628@qq.com

中图分类号: R473.6

收稿日期: 2021-11-11

刊出日期: 2022-02-10

Analysis of predictive factors of tracheotomy in severe neurological patients

- Department of Critical Care Medicine, Xindu District People's Hospital of Chengdu, Chengdu, 610500, China

More Information

Corresponding author: LUO Xianhai, E-mail: 1423440628@qq.com

Received Date: 11 November 2021

Publish Date: 10 February 2022

摘要

摘要: 目的探索神经重症患者气管切开预测因素。方法收集2019年1月1日-2019年12月31日期间我院重症医学科病房的117例神经重症患者的病例资料。根据纳入、排除标准，最终纳入研究对象66例，根据患者住院期间是否行气管切开分为气管切开组(T组，35例)和未行气管切开组(NT组，31例)。比较两组患者性别、年龄、神经重症类型、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS)及气管切开预测因素(损伤部位、弥漫性病变、脑积水、PaO₂/FiO₂ < 150)，对预测因素进行二元logistic回归分析。结果 T组和NT组比较T组患者入院时男性更多，GCS评分更低，APACHE Ⅱ评分更高，脑干、大脑脑室及脑室周围区域损伤占比更高，弥漫性病变占比更高，差异有统计学意义。多因素回归分析显示，脑干损伤(P=0.004)、大脑脑室及脑室周围区域[OR=0.103(0.026~0.419)，P=0.001]、弥漫性病变[OR=0.030(0.003~0.284)，P=0.002]是神经重症患者气管切开的独立预测因素。结论脑干损伤、大脑脑室及脑室周围区域损伤、弥漫性病变是神经重症患者气管切开的预测因素。
- 神经重症 /
- 气管切开 /
- 预测因素
Abstract: Objective To explore the predictive factors of tracheotomy in patients with severe neurological diseases.Methods From January 1, 2019 to December 31, 2019, patients in intensive care unit (ICU) of our hospital were divided into tracheotomy group(T Group) and non tracheotomy group(NT group) according to whether they underwent tracheotomy during hospitalization. Gender, age, type of neurological severity, APACHE Ⅱ score, GCS score and predictive factors of tracheotomy(injury site, diffuse lesions, hydrocephalus, PaO₂ / FiO₂ < 150) were compared between the two groups, and binary logistic regression analysis was performed on the predictive factors.Results Compared with NT group, T group had more males at admission, lower GCS score, higher APACHE Ⅱ score, higher proportion of brain stem, brain ventricle and periventricular area injury, and higher proportion of diffuse lesions. The difference was statistically significant. Multivariate regression analysis showed that brainstem injury(P=0.004), cerebral ventricle and periventricular area[OR=0.103(0.026-0.419),P=0.001]and diffuse lesions[OR=0.030(0.003-0.284),P=0.002]were independent predictors of tracheotomy in patients with severe neurological diseases.Conclusion Brain stem injury, brain ventricle and periventricular area injury and diffuse lesions are predictive factors of tracheotomy in patients with severe neurological diseases.
- severe neurological diseases /
- tracheotomy /
- predictors

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表 1 气管切开组和未行气管切开组基线资料和临床特征比较例, X±S

临床指标	T组	NT组	χ²/F	P
例数	35	31
性别
男	27	13	8.535	0.003
女	8	18
年龄/岁	57.77±13.58	63.39±17.41	2.159	0.147
创伤性颅脑损伤占比/%	45.7	25.8	2.816	0.093
GCS评分	7.00±2.41	11.52±2.00	67.534	0
APACHEⅡ评分	22.43±4.54	19.58±5.86	5.002	0.029
损伤部位/%			15.618	0.001
脑干	14.29	6.45
小脑	0	3.23
大脑皮层或皮层下区域	20.00	64.52
大脑脑室及脑室周围区域	65.71	25.81
弥漫性病变/%	91.43	51.61	13.139	0
脑积水/%	8.57	0	2.784	0.095
PaO₂/FiO₂ < 150/%	8.57	3.23	0.825	0.364

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表 2 神经重症患者气管切开预测因素的logistic回归分析

变量	单因素分析		多因素分析
变量	OR(95%CI)	P	OR(95%CI)	P
损伤部位
脑干		0.004		0.004
小脑	0.870(0.140~5.402)	0.881	6.086(0.395~93.730)	0.195
大脑皮层或皮层下区域	0	1.000	0	1.000
大脑脑室及脑室周围区域	0.122(0.037~0.395)	0	0.103(0.026~0.419)	0.001
弥漫性病变	0.100(0.025~0.396)	0.001	0.030(0.003~0.284)	0.002
脑积水	0	0.999
PaO₂/FiO₂ < 150	0.356(0.035~3.608)	0.382

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