早期气管插管联合镇痛镇静治疗脑梗死合并严重延髓麻痹 的临床分析
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郴州市第一人民医院

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1.湘南学院2021年度校级课题(编号:2021XJ114) 2.郴州市科技局2021年度课题(编号:lcyl2021001)


Clinical Analysis of Early Endotracheal Intubation Combined with Analgesia and Sedation in the Treatment of Cerebral Infarction with Severe Bulbar Palsy
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    摘要:

    目的 脑梗死常合并严重延髓麻痹,传统气管插管时机较迟,本研究的目的是探讨早期气管插管联合镇痛镇静治疗脑梗死合并严重延髓麻痹的效果。方法 2020年5月至2021年5月我科收治的脑梗死并发严重延髓麻痹患者70例,分为早期插管组(35例)和传统插管组(35例),插管后均予以丙泊酚,瑞芬太尼镇痛镇静。比较两组患者指标:插管前及插管后的动脉血气分析指标;气管插管前病情危重程度(NIHSS评分, GCS评分, mRS评分,洼田饮水试验评分,AIS-APS评分);全身并发症(肺部感染,消化道出血,急性心力衰竭,急性肾功能衰竭)的发生率;临床转归及预后:发病至插管时间(h),在ICU住院天数,长期无法拔管患者例数,可拔管患者插管至拔管天数,3个月时预后评价(NIHSS评分,GCS评分,mRS评分,洼田饮水试验评分,AIS-APS评分)。结果 两组患者插管后的动脉血气分析指标均好转(P<0.05);气管插管前,传统插管组病情更严重(P<0.05);早期插管组能明显减少肺部感染,消化道出血,急性心力衰竭发生率(P<0.05),肾功能衰竭有减少趋势,但无统计学差异(P>0.05);早期插管组,发病至插管时间更短(P<0.05);在ICU住院天数更短(P<0.05);长期无法拔管患者例数两组无显著性差异(P>0.05);而可拔管患者插管至拔管时间,早期插管组更短(P<0.05);3个月时早期插管组预后较好(NIHSS评分, GCS评分,mRS评分,洼田饮水试验评分,AIS-APS评分比较,P值均<0.05)。 结论 早期气管插管联合镇痛镇静,能减轻插管前病情严重程度,能减少全身并发症发生率,促进病情恢复,改善远期预后。

    Abstract:

    [Abstract] Objective Cerebral infarction is often complicated with severe bulbar paralysis, and the time of traditional endotracheal intubation is late. The purpose of this study is to explore the effect of early endotracheal intubation combined with analgesia and sedation in the treatment of cerebral infarction complicated with severe bulbar paralysis. Methods From May 2020 to may 2021, 70 patients with cerebral infarction complicated with severe bulbar paralysis were treated in our department. They were divided into early intubation group (35 cases) and traditional intubation group (35 cases). After intubation, propofol and remifentanil were given for analgesia and sedation. The indexes of the two groups were compared: the arterial blood gas analysis indexes before and after intubation; Severity of illness before endotracheal intubation (NIHSS score, GCS score, mRS score, Water swallow test score, AIS-APS score); The incidence of systemic complications (pulmonary infection, gastrointestinal bleeding, acute heart failure, acute renal failure); Clinical outcome and prognosis: time from onset to intubation (h), length of stay in ICU, number of patients unable to extubate for a long time, time from intubation to extubation of extubable patients (days), prognosis evaluation at 3 months (NIHSS score, GCS score, mRS score, Water swallow test score, AIS-APS score)); Results The arterial blood gas analysis indexes were improved in both groups after intubation (P <0.05); Before endotracheal intubation, the condition of traditional intubation group was more serious (P <0.05); Early intubation group can significantly reduce the incidence of lung infection, gastrointestinal bleeding, acute heart failure (P <0.05), renal failure has a decreasing trend, but there is no statistical difference (P >0.05); In the early intubation group, the time from onset to intubation was shorter (P <0.05); The length of stay in ICU was shorter (P <0.05); There was no significant difference between the two groups in the number of patients who could not extubate for a long time (P > 0.05); The time from intubation to extubation in extubable patients was shorter in the early intubation group (P <0.05); The prognosis of early intubation group was better at 3 months (NIHSS score, GCS score, mRS score, Water swallow test score, AIS-APS score, P < 0.05). Conclusion Early tracheal intubation combined with analgesia and sedation can reduce the severity of the disease before intubation, reduce the incidence of systemic complications, promote the recovery of the disease, and improve the long-term prognosis.

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  • 收稿日期:2022-05-11
  • 最后修改日期:2022-07-15
  • 录用日期:2022-08-18
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