影响慢性意识障碍合并气管切开患者拔管因素的分析

何艳斌; 周信杰; 林倩敏; 曹彩云; 谢秋幼

doi:10.16016/j.1000-5404.202102109

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影响慢性意识障碍合并气管切开患者拔管因素的分析

专题报道：意识障碍的基础与临床研究 | 更新时间：2026-01-09

- 影响慢性意识障碍合并气管切开患者拔管因素的分析
- Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness
- 第三军医大学学报 2021年43卷第15期页码：1444-1448
- 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：
  
  [何艳斌, E-mail: heyb_17@sina.com HE Yanbin, E-mail: heyb_17@sina.com
- 基金信息：
  
  广东省重点领域研发计划重大科技专项(2018B030339001);国家自然科学基金面上项目(81974154);广东省工伤康复院内科研项目(KYXM2020A001)
- DOI：10.16016/j.1000-5404.202102109
  中图分类号： R181.32;R655.3;R749.13
- 收稿：2020-02-21，
  
  修回：2021-06-02，
  
  纸质出版：2021-08-15
- 稿件说明：
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何艳斌, 周信杰, 林倩敏, 等. 影响慢性意识障碍合并气管切开患者拔管因素的分析[J]. 第三军医大学学报, 2021,43(15):1444-1448.

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.
何艳斌, 周信杰, 林倩敏, 等. 影响慢性意识障碍合并气管切开患者拔管因素的分析[J]. 第三军医大学学报, 2021,43(15):1444-1448. DOI： 10.16016/j.1000-5404.202102109.

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

NG J, HAMRANG-YOUSEFI S, AGARWAL A. Tracheostomy tube change[EB/OL]. (2021-03-01)[2021-02-21]. https://www.ncbi.nlm.nih.gov/books/NBK555919/.

SANKARI N V, MOHAN J, SIMON P, et al . A new and simple method of fabrication of tracheostomal prosthesis[J ] . J Indian Prosthodont Soc, 2015, 15(1): 76-82. DOI:10.4103/0972-4052.155047.

SINGH R K, SAI S R, BARONIA A K. The practice of tracheostomy decannulation—a systematic review[J]. J Intens Care, 2017, 5: 38. DOI:10.1186/s40560-017-0234-z.

COHEN O, TZELNICK S, LAHAV Y, et al . Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients[J ] . Laryngoscope, 2016, 126(9): 2057-2062. DOI:10.1002/lary.25800.

GIACINO J T, KALMAR K, WHYTE J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility[J]. Arch Phys Med Rehabil, 2004, 85(12): 2020-2029. DOI:10.1016/j.apmr.2004.02.033.

唐志明, 温红梅, 许自阳, 等. 喉镜吞咽功能评估指导气管切开合并吞咽障碍患者拔管的应用分析[J]. 中华物理医学与康复杂志, 2020, 42(10): 886-889. DOI:10.3760/cma.j.issn.0254-1424.2020.10.005.

TANG Z M, WEN H M, XU Z Y, et al . Decannulation of dysphagic patients after a tracheotomy[J ] . Chin J Phys Med Rehabil, 2020, 42(10): 886-889. DOI:10.3760/cma.j.issn.0254-1424.2020.10.005.

TU C S, CHANG C H, CHANG S C, et al . A decision for predicting successful extubation of patients in intensive care unit[J ] . Biomed Res Int, 2018, 2018: 6820975. DOI:10.1155/2018/6820975.

FRUTOS-VI VAR F, ESTEBAN A, APEZTEGUIA C, et al . Outcome of reintubated patients after scheduled extubation[J ] . J Crit Care. 2011;26(5): 502-509. DOI: 10.1016/j.jcrc.2010.12.015.

LIOUTAS V A, HANAFY K A, KUMAR S. Predictors of extubation success in acute ischemic stroke patients[J]. J Neurol Sci, 2016, 368: 191-194. DOI:10.1016/j.jns.2016.07.017.

GARUTI G, REVERBERI C, BRIGANTI A, et al . Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols[J ] . Multidiscip Respir Med,2014, 9(1): 36. DOI:10.1186/2049-6958-9-36.

MITCHELL R B, HUSSEY H M, SETZEN G, et al . Clinical consensus statement: tracheostomy care[J ] . Otolaryngol Head Neck Surg, 2013, 148(1): 6-20. DOI:10.1177/0194599812460376.

THOMAS S, SAUTER W, STARROST U, et al . Time to decannulation and associated risk factors in the postacute rehabilitation of critically ill patients with intensive care unit-acquired weakness: a cohort study[J ] . Eur J Phys Rehabil Med, 2017, 53(4): 501-507. DOI:10.23736/S1973-9087.16.04400-2.

GURU P K, SINGH T D, PED AVALLY S, et al . Predictors of extubation success in patients with posterior Fossa strokes[J ] . Neurocrit Care, 2016, 25(1): 117-127. DOI:10.1007/s12028-016-0249-7.

FUJIWARA K, KAWAMOTO K, SHIMIZU Y, et al . A novel reflex cough testing device[J ] . BMC Pulm Med, 2017, 17(1): 19. DOI:10.1186/s12890-017-0365-y.

朱小芳, 李良海. 使用肾上腺素雾化治疗气管插管拔管后患者喉部水肿的临床研究[J]. 中华临床医师杂志(电子版), 2013, 7(17): 80-83. DOI:10.3877/cma.j.issn.1674-0785.2013.17.025.

ZHU X F, LI L H. Clinical studies of spray treatment on adrenaline after tracheal extubation laryngeal edema[J]. Chin J Clin Electron Ed, 2013, 7(17): 80-83. DOI:10.3877/cma.j.issn.1674-0785.2013.17.025.

DZIEWAS R, MISTRY S, HAMDY S, et al . Design and implementation of Pharyngeal electrical Stimulation for early de-cannulation in TRACheotomized (PHAST-TRAC) stroke patients with neurogenic dysphagia: a prospective randomized single-blinded interventional study[J ] . Int J Stroke, 2017, 12(4): 430-437. DOI:10.1177/1747493016676618.

ALVARENGA A, CAMPOS M, DIAS M, et al . BOTOX-A injection of salivary glands for drooling[J ] . J Pediatr Surg, 2017, 52(8): 1283-1286. DOI:10.1016/j.jpedsurg.2016.09.074.

SARAVANAM P K, JAYAGANDHI S, SHAJAHAN S. Microbial profile in tracheostomy tube and tracheostoma: a prospective study[J]. Indian J Otolaryngol Head Neck Surg, 2019: 1-4. DOI:10.1007/s12070-019-01743-6.

HUANG J T, ZHANG Z W, ZHANG T. Tracheotomy-coblation for acquired subglottic tracheal stenosis: a case report[J]. J Cardiothorac Surg, 2019, 14(1): 128. DOI:10.1186/s13019-019-0947-2.

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