重度获得性脑损伤患者成功拔除气切套管的相关因素分析

doi:10.3969/j.issn.1673-5765.2021.06.011

摘要/Abstract

摘要： 目的探讨重度获得性脑损伤（severe acquired brain injury，sABI）患者成功拔除气切套管的相关影响因素。方法回顾性纳入2017年10月-2019年10月于首都医科大学附属复兴医院康复中心治疗的留置气切套管sABI患者，按照是否成功拔除气切套管分为拔除组和未拔除组。收集纳入患者的基线资料，以及拔管或出院时的意识水平、咳嗽能力、吞咽功能、血氧饱和度、24 h堵管试验、气道狭窄等信息，采用多因素logistic回归分析与成功拔除气切套管相关的因素。结果共纳入160例sABI患者，平均年龄56.13±12.87岁，男性116例（72.5%）；拔除组85例，未拔除组75例，拔管率53.1%。多因素分析结果显示，意识水平较好（微小意识状态：OR 5.668，95%CI 1.270～25.301；脱离微小意识状态：OR 34.670，95%CI 2.570～467.705）、气道无狭窄（OR 45.851， 95%CI 3.290～638.914）、通过24 h堵管试验（OR 96.069，95%CI 9.799～941.897）是成功拔除气切套管的独立预测因素。结论在sABI患者中，微小及脱离微小意识状态、连续堵管超过24 h、气道无明显狭窄是成功拔除气切套管的独立预测因素。

文章导读： 本研究发现微小及脱离微小意识状态、连续堵管超过24 h、气道无明显狭窄是成功拔除气切套管的独立预测因素，为合理评估拔除气切套管提供参考。

关键词: 拔除气切套管; 拔管指征; 重度获得性脑损伤; 预测因素; 康复

Abstract: Objective To identify the predictors for tracheostomy decannulation in patients with severe acquired brain injury (sABI). Methods This retrospective study enrolled sABI patients with tracheostomy tubes who underwent rehabilitation in Rehabilitation Medicine Center, Fuxing Hospital from October 2017 to October 2019. All the subjects were divided into the decannulation group and non-decannulation group based on successful decannulation. The collected data included baseline information, consciousness state, reflex cough ability, swallowing function, oxyhemoglobin saturation (SPO2>95%), tracheostomy tube capping for 24 hours, and endoscopic assessment of airway patency (lumen diameter>50%). Univariate and multivariate analysis were used to analyze the factors associated with successful tracheostomy decannulation. Results A total 160 sABI patients were included, with a mean age of 56.13±12.87 years and 116 males (72.5%). Decannulation was performed in 85 patients (53.1%). Multivariate logistic regression analysis showed that successful decannulation was associated with consciousness state (minimal conscious state: OR 5.668, 95%CI 1.270-25.301; out of minimal conscious state: OR 34.670, 95%CI 2.570-467.705), airway patency (OR 45.851, 95%CI 3.290-638.914), tracheostomy tube capping for 24 hours (OR 96.069, 95%CI 9.799-941.897).

Conclusions The consciousness state, tracheostomy tube capping for 24 hours and airway patency

were independent predictors for the successful tracheostomy decannulation in sABI patients.

Key words: Tracheostomy decannulation; Decannulation indictor; Severe acquired brain injury;Predictor; Rehabilitation

宋璐, 王泳, 李海东, 刘洁, 李征, 张文静, 高亚立, 刘月伟, 陆敏杰. 重度获得性脑损伤患者成功拔除气切套管的相关因素分析[J]. 中国卒中杂志, 2021, 16(07): 699-704.

SONG Lu, WANG Yong, LI Hai-Dong, LIU Jie, LI Zheng, ZHANG Wen-Jing, GAO Ya-Li, LIU Yue-Wei, LU Min-Jie. Predictors of Tracheostomy Decannulation in Patients with Severe Acquired Brain Injury[J]. Chinese Journal of Stroke, 2021, 16(07): 699-704.

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