【作者】 陈媛媛；

【导师】 张睢扬；

【作者基本信息】 苏州大学 ， 呼吸内科（专业学位）， 2013， 硕士

【摘要】 目的探讨长期机械通气的原因，比较留置不同人工气道的长期机械通气患者并发症、住院死亡率及生存时间的差异性，分析两组患者主要并发症的原因、防治方式及合理有效地人工气道的选择、管理方法。方法回顾性分析我院2007年3月～2012年3月间125例长期机械通气患者（>21d）的病历资料，探讨长期机械通气的原因，并根据人工气道的不同分为经鼻气管插管组及气管切开组，其中经鼻气管插管组76例，气管切开组49例，对两组患者的并发症发生率、住院死亡率及生存时间做统计学分析，比较两组之间的差异性。结果1.两组间性别，年龄，留置人工气道时呼吸衰竭类型、急性生理学及慢性健康状态评分（APACHEⅡ评分）均无统计学差异。2.两组患者长期机械通气的原因，肺部疾病占56.80%，神经肌肉疾病、脑血管意外、心脏疾病、多器官功能衰竭、心理因素、外科术后分别占9.60%、9.60%、8.80%、8.00%、4.80%、2.40%。3.与气管切开组患者比较，经鼻气管插管组患者鼻窦炎的发生率显著高，为13.15%，差异具有统计学意义（χ2=4.59，P<0.05）。经鼻气管插管组和气管切开组的其他并发症的发生率分别为：呼吸机相关性肺炎32.89%vs28.57%，χ2=0.26，P=0.61；气管食管瘘2.63%vs2.04%，χ2=0.04，P=0.83；气管狭窄1.31%vs4.08%，χ2=0.97，P=0.32；气管软化1.31%vs6.12%，χ2=2.22，P=0.14；气管内出血1.31%vs2.04%，χ2=0.10，P=0.75；套管堵塞1.31%vs2.04%，χ2=0.10，P=0.75；差异均无统计学意义。4.两组患者比较，经鼻气管插管组患者死亡39例，死亡率为51.32%，平均生存时间163.37±26.16天，气管切开组患者死亡15例，死亡率30.61%，平均生存时间378.79±97.80天，P<0.05，差异具有统计学意义。结论1.长期机械通气的原因，以肺部疾病为主，神经肌肉疾病、脑血管意外、心脏疾病、多器官功能衰竭、外科术后、心理因素也占据一定的比例。2.与气管切开组患者比较，长期留置经鼻气管插管组患者鼻窦炎发生率显著升高；呼吸机相关性肺炎、气管食管瘘、气管狭窄、气管软化、气管内出血、套管堵塞等并发症发生率在两组间无显著性差异。3.相比较于经鼻气管插管组患者，气管切开组患者死亡率较低，生存时间较长。4.对于长期机械通气的患者，做好留置人工气道方式的选择，对于减少患者鼻窦炎的发生，延长生存时间，降低死亡率具有重要的意义。更多还原

【Abstract】 ObjectiveTo explore the Etiology for prolonged mechanical ventilation (PMV), compare the complications, hospital mortality and survival time with different artificial airway in patients undergoing prolonged mechanical ventilation, analysis the causes and prevention of major complications of the two groups, explore the rational and effective selection and management of artificial airway.MethodsThis was a retrospective observational study of125patients who received prolonged mechanical ventilation in our ICU between March2007and March2012. Explore the etiology of PMV. According to the artificial airway,125patients were divided into two groups:the nasotracheal tubated group(76patients) And the tracheostomized group(49patients), complications, hospital mortality and survival time were compared between the two groups.Results1.There were no difference between the two groups in gender, age, respiratory failure type, acute physiology and chronic health status score (APACHE II score).2.Lung diseases(56.80%)were the main reason for patients undergoing prolonged mechanical ventilation. Meanwhile, other reasons such as neuromuscular diseases(9.60%), cerebrovascular accident(9.60%), heart disease(8.80%), multiple organ failure(8.00%), psychological factors(4.80%) and surgery(2.40%) could also lead to prolonged mechanical ventilation.3.There was significantly higher in the incidence of sinusitis in the the nasotracheal tubated group (13.15%),(χ2=4.59, P<0.05). There were no significant difference between two groups in the incidence of other complications:ventilator-associated pneumonia(VAP)32.89%vs28.57%, χ2=026, P=0.61; tracheoesophageal fistula(TEF)2.63%vs2.04%, χ2=0.04, P=0.83; tracheal stenosis1.31%vs4.08%, χ2=0.97, P=0.32; the tracheomalacia1.31%vs6.12%, x2=2.22, P=0.14; tracheal hemorrhage1.31%vs2.04%, χ2=0.10, P0.75; casing blockage1.31%vs2.04%,χ2=0.10, P=0.75.4. In the nasotracheal tubated group,39cases were dead, the mortality rate was51.32%, the average survival time was163.37±26.16days. In the tracheostomized group,15cases were dead, the mortality rate was30.61%, the average survival time was378.79±97.80days, P<0.05, there was a significant difference between the two groups.Conclusions1.Lung diseases were the main reason for patients who required prolonged mechanical ventilation, Neuromuscular diseases, cerebrovascular accident, heart diseases, multiple organ failure, surgery and psychological factors also occuped a certain proportion.2.Compared with patients in tracheostomized group, there was a higher incidence of sinusitis in the nasotracheal tubated group; there were no difference between VAP, tracheoesophageal fistula, tracheal stenosis, tracheomalacia, tracheal hemorrhage, casing blockage.3. Compared with patients in nasotracheal tubated group, there was a lower hospital mortality and a longer survival time in the tracheostomized group.4. There’s a great significance in reducing the incidence of sinusitis, prolonging the survival time and reducing the hospital mortality to choose the right artificial airway for the patients undergoing prolonged mechanical ventilation.更多还原