气管切开后拔管策略对拔管成功率的影响

doi:10.3969/j.issn.1006-9771.2018.09.016

摘要/Abstract

摘要： 目的优化气管切开后导管拔管策略。方法 2016年8月至2018年4月脑损害气管切开术后患者118例,分为早期拔管组(n=74)和传统拔管组(n=44),比较两组拔管成功率、耐受程度,拔管前和拔管后7 d检测患者血生化指标。早期拔管组再分为一次性拔管组(n=37)和先堵管后拔管组(n=37),比较两组拔管成功率。结果早期拔管组和传统拔管组间拔管成功率无显著性差异(χ²=0.016, P>0.05)。早期拔管组拔管当日耐受性较低(χ²=4.909, P<0.05),拔管7 d、15 d后耐受性无显著性差异(χ²<1.995, P>0.05)。拔管后7 d,患者降钙素原、超敏C反应蛋白和白细胞计数均下降(t>2.680, P<0.05),血红蛋白和白蛋白显著升高(t>11.620, P<0.001)。一次性拔管组与先堵管后拔管组成功率无显著性差异(χ²<2.902, P>0.05)。结论有良好咳嗽和吞咽功能为拔管成功的决定性因素,其余拔管指征对拔管成功与否无决定性影响,但影响耐受性;拔管对控制患者并发症有利。一次性拔管法有其优势。

关键词: 气管切开, 早期拔管, 一次性拔管法, 耐受, 并发症

Abstract: Objective To optimize the ways of extubation after tracheotomy.Methods From August, 2016 to April, 2018, 118 patients after tracheotomy for brain injury were divided into early extubation group (n=74) and conventional extubation group (n=44). The success rate and tolerance of extubation were compared, and the biochemical markers of blood were tested before and seven days after extubation. The early extubation group was divided into disposable extubation group (n=37) and occlusion tube-extubation group (n=37), and their success rates of extubation were compared.Results There was no significant difference in success rate between the early extubation group and the conventional extubation group (χ²=0.016, P>0.05). The tolerance was less in the early extubation group on the first day of extubation (χ²=4.909, P<0.05), and it was not different seven days and 15 days after extubation (χ²<1.995, P>0.05). The procalcitonin, hypersensitive C reactive protein and white blood cell count decreased (t>2.680, P<0.05), and hemoglobin and albumin increased seven days after extubation (t>11.620, P<0.001). There was no significant difference in the success rate between the disposable extubation group and the occlusion tube-extubation group (χ²<2.902, P>0.05).Conclusion Satisfactory cough and deglutition reflex are the core indexes of successful extubation, other indications may not influence on the success of extubation but on tolerance. Extubation may benefit to control the complications of tracheotomy. The disposable extubation is more recommended.

Key words: tracheotomy, early extubation, disposable extubation, tolerance, complications

中图分类号:

R742

夏嘉川, 罗忠纯, 郭祥奎, 邓强, 杨雪, 叶茜. 气管切开后拔管策略对拔管成功率的影响[J]. 《中国康复理论与实践》, 2018, 24(9): 1067-1071.

XIA Jia-chuan, LUO Zhong-chun, GUO Xiang-kui, DENG Qiang, YANG Xue, YE Xi. Comparison of Ways of Extubation after Tracheotomy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(9): 1067-1071.

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