王绍玮,曾西,李庆福,等.影响持续植物状态合并气管切开患者拔管的相关因素分析[J].中华物理医学与康复杂志,2022,44(10):907-911
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| 影响持续植物状态合并气管切开患者拔管的相关因素分析 |
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| DOI：10.3760/cma.j.issn.0254-1424.2022.10.009 |
| 中文关键词: 持续植物状态 气管切开 拔管 影响因素 |
| 英文关键词: Vegetative state Tracheotomy Extubation |
| 基金项目:中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助（2020-PT310-01）；河南省医学科技攻关项目（201602099） |
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| 中文摘要: |
| 目的 探讨影响持续植物状态（PVS）合并气管切开患者拔管的相关因素，为PVS患者尽早拔除气切管提供参考资料。 方法 收集2020年1月至2022年1月期间在郑州大学第一附属医院康复医学科治疗的PVS合并气管切开患者的临床资料，根据在院期间是否成功拔除气切管将其分为拔管组和拔管困难组。采用SPSS 22.0版统计学软件包对拔管影响因素进行单因素及多因素Logistic回归分析。 结果 经单因素分析发现，拔管组与拔管困难组在年龄、专业护理、营养方式、吞咽功能、是否低蛋白血症及带管时间方面组间差异均有统计学意义(P＜0.05），两组患者在性别、颅脑损伤、脑卒中、缺血缺氧性脑病、是否气管结构异常、是否肺部感染方面组间差异均无统计学意义（P＞0.05）。经多因素Logistic回归分析发现，营养方式、吞咽功能、带管时间、肺部感染情况、专职陪护、年龄均为PVS合并气管切开患者拔管的独立影响因素(P＜0.05）。 结论 采用间歇经口至食管管饲法（IOE）作为营养方式、有专职陪护为PVS合并气管切开患者拔管的保护因素；吞咽障碍、带管时间＞30 d、肺部感染、年龄较大为PVS合并气管切开患者拔管的危险因素。对于PVS合并气管切开患者，待其病情稳定后，尽早给予IOE营养支持、吞咽功能训练及加强护理可有效提高患者拔管成功率。 |
| 英文摘要: |
| Objective To explore the factors influencing the extubation time of patients in a persistent vegetative state (PVS) after tracheotomy so as to provide a theoretical basis for early extubation for such patients. Methods Clinical data were collected on PVS patients after a tracheotomy. The cases were divided into an extubation group and a difficult extubation group according to whether the extubation was successful or not. Version 22.0 of the SPSS software was used to evaluate univariate and multivariate logistic regressions analyzing the factors influencing the success of extubation. Results The single-factor analysis revealed significant differences between the groups in terms of average age, nursing level, nutrition, swallowing function, hypoalbuminemia and incubation time. Gender, brain injury, stroke, ischemic anoxic encephalopathy and lung infection were not, however, significant predictors. The multivariate logistic regression analysis highlighted nutritional mode, swallowing function, intubation time, pulmonary infection, full-time care and age as independent predictors of extubation success. Conclusions Intermittent oral to esophageal tube feeding and full-time care are protective factors for extubation of patients in a PVS after a tracheotomy. Swallowing disorders, intubation for more than 30 days, pulmonary infection and greater age are risk factors for unsuccessful extubation. Nutritional support, swallowing function training and intensive nursing can effectively improve the success rate of extubation. |
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