颅脑术后加强监护病房患者气管切开时机与住院预后的关系

Association between tracheostomy timing and prognosis in patients admitted to the intensive care unit after cranial surgery

摘要:

目的 研究神经外科颅脑病变术后加强监护病房（ICU）患者气管切开时机对临床住院预后的影响。方法 采用回顾性队列研究设计，选取2023年7月—2024年7月首都医科大学附属北京天坛医院重症医学科颅脑术后予气管切开的患者188例。根据气管插管至气管切开的时间，将患者分为早期气管切开组（≤7 d）和晚期气管切开组（＞7 d）。收集并比较两组患者的基线资料及临床结局，分析评估气管切开时机对住院预后的影响。结果 共纳入188例患者，其中早期气管切开组49例，晚期气管切开组139例。多因素分析显示，早期气管切开组中脑肿瘤术后患者占比及咳嗽反射障碍发生率高于晚期气管切开组（P＜0.05）；早期气管切开组呼吸机相关肺炎发生率低于晚期气管切开组（P＜0.05）；早期气管切开术是减少ICU停留时间、总住院时间及总住院费用的影响因素（P＜0.05）。结论 对于神经外科颅脑术后患者，尤其是脑肿瘤合并咳嗽反射障碍的患者，早期（≤7 d）予气管切开可降低肺部感染发生率，缩短机械通气时间、ICU停留时间及总住院时间，并减少总住院费用。

Abstract:

Objective To investigate the impact of tracheostomy timing on clinical prognosis in patients admitted to the intensive care unit （ICU） after neurosurgical cranial surgery.Methods A retrospective cohort study was conducted among 188 patients who underwent tracheostomy after cranial surgery in Department of Critical Care Unit， Beijing Tiantan Hospital， Capital Medical University， from July 2023 to July 2024， and according to the time from intubation to tracheostomy， they were divided into early tracheostomy group （≤7 days） and late tracheostomy group （>7 days）. Baseline data and clinical outcomes were collected and compared between the two groups， and the univariate and multivariate analyses were used to assess the impact of tracheostomy timing on prognosis.Results A total of 188 patients were enrolled， with 49 in the early tracheostomy group and 139 in the late tracheostomy group. The multivariate analysis showed that compared with the late tracheostomy group， the early tracheostomy group had a significantly higher proportion of patients undergoing brain tumor surgery and a significantly higher incidence rate of cough reflex impairment （P<0.05）， as well as a significantly lower incidence rate of ventilator-associated pneumonia （P<0.05）. Early tracheostomy was an independent influencing factor for reducing the length of ICU stay， the total length of hospital stay， and hospital costs （P<0.05）.Conclusions For patients after neurological cranial surgery， especially those with brain tumor and impaired cough reflex， early tracheostomy （≤7 days） can significantly reduce the incidence rate of pulmonary infections， shorten the duration of mechanical ventilation， the length of ICU stay， and the total length of hospital stay， and reduce hospital costs.