持续植物状态气管切开插管两种拔管方式的对照研究

发布时间：2018-01-05 01:11

本文关键词：持续植物状态气管切开插管两种拔管方式的对照研究　出处：《中国康复医学杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的:比较持续植物状态(PVS)气管切开插管患者两种不同拔管方式(封拔法和换封拔法)的效果。方法:我院植物状态促醒中心(123例)入组PVS气管切开插管患者随机分为封拔2步法组、换封拔3步法组。封拔2步法组使用自制封管套封管全封堵48h后,如果呼吸正常者直接拔出套管。换封拔3步法组先更换金属套管1周后,封管24—48h,如果呼吸正常者则拔出套管。记录从封管至拔管过程中患者心率、呼吸、血氧饱和度变化以及不同性别、病程、气管套管留置时间、拔管时间、拔管成功率及并发症的发生率。结果:(1)两组拔管时间比较,封拔2步法组拔管时间明显短于换封拔3步法组(P=0.034);两组患者病程为4—12周,比较差异更明显(P0.05);脑外伤、高血压脑出血患者拔管时间比较,封拔2步法组的拔管时间也明显短于换封拔3步法组(P0.05)。(2)两组拔管成功率、并发症发生率比较无显著性差异(P0.05)。结论:两种拔管方式的安全性、成功率、并发症发生率相同,但封拔2步法的拔管时间较短,特别是病程为4—12周、病因为脑外伤与高血压脑出血者,更加短于换封拔3步法。
[Abstract]:Objective: to compare the effects of two different extubation methods (sealing and replacement) in patients with tracheotomy and intubation for persistent vegetative state PVS. Methods: 123 cases of prowakening center in our hospital). Patients with tracheotomy and intubation by PVS were randomly divided into two steps group. After 48 hours of complete plugging with self-made tube-sealing sleeve, if the person with normal breathing was directly pulled out of the casing, the 3-step replacement group first changed the metal casing after 1 week. For 24-48 h, if the breath was normal, the cannula was pulled out. The heart rate, respiration, blood oxygen saturation, gender, course of disease, and the duration of trachea cannula retention were recorded during the course of tube sealing and extubation. Results the extubation time of the two groups was significantly shorter than that of the 3-step replacement group. The course of disease was 4-12 weeks in the two groups, and the difference was more obvious than that in the control group (P 0.05). Compared with the extubation time of the patients with cerebral trauma and hypertensive intracerebral hemorrhage, the extubation time of the two steps group was significantly shorter than that of the 3-step replacement group. There was no significant difference in the incidence of complications (P 0.05). Conclusion: the safety, success rate and complication rate of the two extubation methods are the same, but the extubation time of two steps is shorter. The course of disease was 4-12 weeks, the etiology was cerebral trauma and hypertensive intracerebral hemorrhage, which was shorter than that of three steps.
【作者单位】：广东三九脑科医院;中山大学孙逸仙纪念医院;解放军第四五八医院;
【分类号】：R472
【正文快照】： 气管切开术是意识障碍患者常用的手术,病情稳时间为(101.1±47.1)d;换封拔3步法组60例,男女定后尽早拔除气管插管可减少患者潜在的并发症[1],各31、29例,年龄(44.6±13.2)岁,其中脑外伤、高血有助于患者早日康复。目前气管拔管操作较普遍的压脑出血、动静脉畸形、缺血缺氧性脑

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