气管切开术后拔管困难患者成功拔除气切套管的相关因素分析

关键词：气管切开术后拔管困难  拔除气切套管  呼吸康复  上气道通畅  分泌物管理

Keywords:difficult decannulation  tracheostomy decannulation  pulmonary rehabilitation  upper airway patency  secretion management

摘要：

      摘要 目的：探讨气管切开术后拔管困难患者成功拔除气切套管的相关影响因素。 方法：回顾性纳入2020年1月—2022年1月于首都医科大学附属北京康复医院呼吸与危重症医学科收治的拟行拔管的气管切开术后拔管困难患者，给予呼吸康复治疗后，按照是否成功拔除气切套管分为拔管组和未拔管组。收集纳入患者的基线资料，以及拔管前或出院时的意识水平、氧分压、机械通气时间、上气道通畅情况、分泌物管理能力、能否耐受连续佩戴语音阀4h、咳嗽能力、吞咽能力等信息，采用二元logistic回归分析成功拔除气切套管的相关因素。 结果：共纳入96例气管切开术后拔管困难患者，男性67例，女性29例，平均年龄（63.99±15.69）岁，拔管组60例和未拔管组36例。logistic回归分析显示，上气道通畅（OR 11.882，95%CI 1.181—119.519）、分泌物管理良好（OR 11.512，95%CI 1.866—71.021）、能耐受4h语音阀佩戴（OR 49.217，95%CI 5.040—480.594）、PCF＞100L/min（OR 11.527，95%CI 1.053—126.121）有显著性意义。 结论：气管切开术后困难拔管患者中，上气道通畅、分泌物管理良好、能耐受4h语音阀佩戴、咳嗽能力良好是成功拔除患者气切套管的独立预测因素。

Abstract:

      Abstract Objective: To investigate the related factors of successful tracheostomy decannulation in patients with difficulty in decannulation. Method: Retrospective inclusion criteria included patients with difficulty in decannulation with an indwelling tracheostomy tube who were hospitalized to the Department of Respiratory and Critical Care Medicine， Beijing Rehabilitation Hospital of Capital Medical University from January 2020 to January 2022. All the patients were divided into the decannulation group and non-decannulation group based on whether a success of tracheostomy decannulation or not. The baseline information of the included patients were collected, along with the level of consciousness, partial pressure of oxygen, time of mechanical ventilation, upper airway patency, secretion management ability, tolerance to 4-hour voice valve wearing, cough ability, and swallowing ability before decannulation or at discharge. Binary logistic regression was used to examine the variables that contributed to the removal of the tracheostomy tube being successful. Result: A total of 96 patients with difficulty in decannulation were included in the study; there were 67 males and 29 females, with an average age of 63.99±15.69. The decannulation group included 60 patients, while the non-decannulation group included 36 patients. Logistic regression analysis showed that upper airway patency (OR 11.882，95%CI 1.181—119.519), good secretion management (OR 11.512, 95%CI 1.866—71.021), tolerance to 4-hour voice valve wearing (OR 49.217, 95%CI 5.040—480.594), PCF>100L/min (OR 11.527, 95%CI 1.053—126.121) have statistical significance. Conclusion: Upper airway patency, good secretion management, tolerance to 4-hour voice valve wearing, and good coughing ability are all independent predictors of successful tracheotomy tube removal in patients with difficulty in decannulation after tracheotomy.