气管切开时机对颅脑术后ICU患者临床预后的影响

Impact of Tracheostomy Timing on Clinical Outcomes in ICU Patients After Cranial Surgery

摘要:

目的 本研究旨在探讨神经外科颅脑术后重症监护室（ICU）患者气管切开时机对住院预后的影响。方法 采用回顾性队列研究方法，纳入2023年7月至2024年7月首都医科大学附属北京天坛医院重症医学科收治的神经外科颅脑术后行气管切开患者，根据气管插管至气管切开的时间分为早期气管切开组（≤7天）和晚期气管切开组（＞7天）。通过比较两组基线资料及临床结局，并采用多因素回归分析评估气管切开时机对预后的影响。结果 共纳入188例患者，其中早期气管切开组中49例，晚期气管切开组中139例。多因素分析结果显示，早期气管切开组中的脑肿瘤术后患者比例及咳嗽反射障碍发生率显著高于晚期组（P＜0.05），但呼吸机相关性肺炎发生率显著降低（P＜0.05）。早期气管切开是缩短ICU住院时间、总住院时间及降低住院费用的独立影响因素（P＜0.05）。结论 对于神经外科颅脑术后患者，尤其是脑肿瘤伴咳嗽反射障碍者，早期（≤7天）气管切开可有效减少呼吸机相关性肺炎、缩短机械通气及住院时间，并显著降低医疗成本。

Abstract:

Objective: To investigate the impact of tracheostomy timing on hospitalization outcomes in neurosurgical patients admitted to ICU after craniotomy. Methods: A retrospective cohort study was conducted on neurosurgical patients who underwent tracheostomy after craniotomy in the Department of Critical Care Unit, Beijing Tiantan Hospital, Capital Medical University, from July 2023 to July 2024. Patients were divided into early tracheostomy group (≤7 days) and late tracheostomy group (>7 days) based on the time from endotracheal intubation to tracheostomy. Baseline characteristics and clinical outcomes were compared between the two groups, and multivariate regression analysis was used to evaluate the effect of tracheostomy timing on prognosis. Results: A total of 188 patients were included, with 49 in the early tracheostomy group and 139 in the late tracheostomy group. Multivariate analysis showed that the early tracheostomy group had significantly higher proportions of post-brain tumor surgery patients and cough reflex impairment (P<0.05), but significantly lower incidence of ventilator-associated pneumonia (P<0.05). Early tracheostomy was an independent factor for reducing ICU stay, total hospitalization time and hospitalization costs (all P<0.05). Conclusion: For neurosurgical patients after craniotomy, especially those with brain tumors and cough reflex impairment, early tracheostomy (≤7 days) can effectively reduce ventilator-associated pneumonia, shorten mechanical ventilation and hospitalization time, and significantly decrease medical costs.