Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness

Yanbin HE; Xinjie ZHOU; Qianmin LIN; Caiyun CAO; Qiuyou XIE

doi:10.16016/j.1000-5404.202102109

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Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness

Monographic Reports : Basic and clinical studies for disorders of consciousness | 更新时间：2026-01-09

- Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness
- Journal of Third Military Medical University Vol. 43, Issue 15, Pages: 1444-1448(2021)
- 作者机构：
  
  1.510440 广州，广东省工伤康复医院颅脑损伤康复&重症康复科
  2.510282 广州，南方医科大学珠江医院康复医院科
- 作者简介：
- 基金信息：
  
  the Major Project of Key R&D Program of Guangdong Province(2018B030339001);the General Program of National Natural Science Foundation of China(81974154);the Medical Research Project of Guangdong Provincial Work Injury Rehabilitation Hospital(KYXM2020A001)
- DOI：10.16016/j.1000-5404.202102109
  CLC： R181.32;R655.3;R749.13
- Received：21 February 2020，
  
  Revised：2021-06-02，
  
  Published：15 August 2021
- 稿件说明：
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Yanbin HE, Xinjie ZHOU, Qianmin LIN, et al. Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness[J]. Journal of Third Military Medical University, 2021, 43(15): 1444-1448.
DOI：

Yanbin HE, Xinjie ZHOU, Qianmin LIN, et al. Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness[J]. Journal of Third Military Medical University, 2021, 43(15): 1444-1448. DOI： 10.16016/j.1000-5404.202102109.

摘要

目的

分析影响慢性意识障碍合并气管切开患者拔管的因素。

方法

回顾性分析2019年1月至2020年10月在广东省工伤康复医院颅脑损伤康复科住院的59例意识障碍合并气管切开的患者资料，入选病例根据是否拔管分成拔管组和不能拔管组，拔管组30例，不能拔管组29例，总结其年龄、病因、病程(发病至拔管时间)、气管切开状态时间、修订版昏迷恢复量表(Coma recovery scale-revised，CRS-R)总分、CRS-R运动项评分、CRS-R言语项评分、咳嗽廓清痰液能力、可视纤支镜检查查看分泌物量、咽喉水肿情况、气道狭窄与拔管成功与否的关系。

结果

拔管组和不能拔管组年龄、性别、病因病程、气管切开状态时间的差异均无统计学意义；CRS-R总分、CRS-R运动项评分≥3分、CRS-R言语项评分≥1分，拔管组均高于后者(

0.05)；咳嗽廓清痰液能力高于后者(

0.05)；咽喉水肿、分泌物残留分级≤1级、气道狭窄较后者发生率少(

0.05)；在Logistic回归分析发现，气道梗阻(

=0.001)、唾液异常分泌

(

=0.001)以及CRS-R评分(

=0.036)是影响拔管的显著因素。

结论

慢性意识障碍合并气管切开患者拔管与病程、意识状态、咳嗽反射、咽喉水肿、分泌物、气管狭窄等因素有关。

Abstract

Objective

To analyze the influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness.

Methods

Clinical data of 59 cases with prolonged disorders of consciousness and having undergone tracheotomy in Guangdong Provincial Work Injury Rehabilitation Hospital from January 2019 to October 2020 were collected and retrospectively analyzed in this study. The patients were divided into extubation group (

=30) and non-extubation group (

=29). Age

cause of disease

duration of diseases (time from onset to extubation)

duration of tracheostomy

total score and scores of functional mobility and language in Coma Recovery Scale-Revised (CRS-R)

airway clearance by coughing

amount of expectation (evaluated by bronchofiberscopy)

laryngeal edema and tracheal stenosis were analyzed to assess their relationships with tracheostomy decannulation.

Results

There were no statistical differences in age

gender

cause of disease

duration of diseases and average duration of tracheal intubation between the 2 groups. The extubation group had significantly higher total score of CRS-R

larger proportions of those with the score of functional mobility ≥3 and that of language ≥1

better airway clearance by coughing

milder laryngeal edema

lower proportion of residual expectation grade ≤l

and lower incidence of tracheal stenosis when compared with the non-exubation group (all

0.05). Logistic regression analysis showed that tracheal obstruction (

=0.001)

abnormal salivary secretion (

=0.001) and CRSR-R score (

=0.036) were significant factors influencing extubation.

Conclusion

Tracheostomy decannulation is closely related to duration of disease

conscious status

cough reaction

laryngeal edema

amount of phlegm

and airway stenosis.

关键词

Keywords

references

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