改良型气管切开套管组件在自发性脑出血患者中的临床应用效果

Clinical efficacy of a modified tracheostomy tube set for patients with spontaneous intracerebral hemorrhage

摘要:

目的 评价改良型气管切开套管组件在自发性脑出血（SICH）患者中的应用效果。方法 分析2021年2月─2022年5月在河南省南阳市中心医院行气管切开的84例SICH患者临床资料，其中，42例采用一次性气管套管行气管切开（对照组），另42例采用改良型气管切开套管组件行气管切开（研究组）。比较两组患者血气分析值、炎症反应指标、临床肺部感染评分（CPIS）、拔管时间及日均气道护理时间。结果 治疗前两组患者的血氧分压（PaO₂）、二氧化碳分压（PaCO₂）、血氧饱和度（SaO₂）、pH值等血气指标，白介素8（IL-8）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）等炎症反应指标，以及CPIS差异均无统计学意义（P>0.05）。治疗后，两组PaO₂、SaO₂、pH值均较治疗前升高，而PaCO₂降低，但研究组以上血气指标治疗前后的变化程度大于对照组（P<0.05）；两组IL-8、hs-CRP及TNF-α水平较治疗前均有降低，但研究组以上炎症反应指标治疗前后的变化程度大于对照组（P<0.05）；两组CPIS评分均较治疗前降低，但研究组的CPIS评分治疗前后降低程度大于对照组（P<0.05）。此外，研究组的气管套管留置时间、日均气道护理时间少于对照组（P<0.05）。结论 改良型气管切开套管组件可更为有效地改善SICH气管切开患者肺功能与血气指标，减轻炎症反应，缩短气管套管留置时间，降低护理难度，具有一定的临床应用价值。

Abstract:

Objective To investigate the application effectiveness of a modified tracheostomy tube set in patients with spontaneous intracerebral hemorrhage （SICH）.Methods A retrospective analysis was performed for the clinical data of 84 SICH patients who underwent tracheostomy in Nanyang Central Hospital from February 2021 to May 2022， among whom 42 patients underwent tracheotomy with a standard disposable tracheostomy tube （control group） and 42 patients underwent tracheostomy with the modified tracheostomy tube set （study group）. The two groups were compared in terms of blood gas parameters， inflammation markers， pulmonary infection score， extubation time， and daily mean airway care time.Results Before treatment， there were no significant differences between the two groups in blood gas parameters （partial pressure of oxygen ［PaO₂］， partial pressure of carbon dioxide ［PaCO₂］， blood oxygen saturation ［SaO₂］， and pH value）， inflammatory response indicators （interleukin-8 ［IL-8］， high-sensitivity C-reactive protein ［hs-CRP］， and tumor necrosis factor-alpha ［TNF-α］）， and Clinical Pulmonary Infection Score （CPIS） （P >0.05）. After treatment， both groups had significant increases in PaO₂， SaO₂， and pH value and a significant reduction in PaCO₂， and the study group had significantly greater changes in these indicators compared with the control group （P <0.05）； both groups had significant reductions in IL-8， hs-CRP， and TNF-α， and the study group had significantly greater reductions than the control group （P <0.05）； both groups had a significant reduction in CPIS， and the study group had a significantly greater reduction than the control group （P <0.05）. In addition， compared with the control group， the study group had significantly shorter tracheostomy tube retention time and daily mean airway care time （P <0.05）.Conclusions For SICH patients undergoing tracheostomy， the modified tracheostomy tube set can effectively improve lung function and blood gas parameters， alleviate inflammatory response， shorten tracheostomy tube retention time， and reduce the difficulty in airway management， and therefore， it has a certain clinical application value.