Zhongguo cuzhong zazhi (Mar 2023)
重症卒中患者早期不同气道开放方式对肺部感染及气管插管的影响 Effects of Early Different Airway Opening Mode on Pulmonary Infection and Tracheal Intubation in Patients with Severe Stroke
Abstract
目的 研究重症卒中患者早期应用口咽通气管或鼻咽通气管的临床应用效果。 方法 连续纳入2020年6月—2022年6月首都医科大学附属北京天坛医院急诊抢救室收治的重症卒中患者，根据患者留置口咽通气管、鼻咽通气管、未留置口/鼻咽通气管分为口咽通气管组、鼻咽通气管组、对照组，对其临床资料进行回顾性分析。比较各组间临床特征、入院7 d内肺部感染发生情况、序贯气管插管转化率及转化时间。 结果 共纳入213例重症卒中患者，男性123例，脑出血119例，脑梗死94例。鼻咽通气管组79例，口咽通气管组68例，对照组66例。鼻咽通气管组入院7 d内误吸发生率低于对照组（10.13% vs. 19.70%，P=0.034）及口咽通气管组（10.13% vs. 22.06%，P=0.021）。鼻咽通气管组入院7 d内肺部感染发生率低于对照组（32.91% vs. 59.09%，P=0.018）与口咽通气管组（32.91% vs. 45.59%，P=0.023）。鼻咽通气管组、口咽通气管组、对照组三组7 d院内全因死亡率（30.38% vs. 32.35% vs. 34.84%，P=0.660）整体差异无统计学意义。鼻咽通气管组7 d内气管插管转化率低于口咽通气管组（12.66% vs. 44.12%，P=0.022）与对照组（12.66% vs. 43.94%，P=0.031）。鼻咽通气管组气管插管转化时间较口咽通气管组[（6.72±2.15）d vs.（4.12±1.23）d，P=0.022]、对照组[（6.72±2.15）d vs.（3.12±1.33）d，P=0.011]延长。入院7 d血气分析可见鼻咽通气管组[（83.56±8.31）mmHg vs.（76.34±8.63）mmHg，P=0.007]及口咽通气管组[（84.56±5.84）mmHg vs.（76.34±8.63）mmHg，P=0.003]血氧分压高于对照组，而鼻咽通气管组[（37.67±11.22）mmHg vs.（48.56±9.62）mmHg，P=0.012]及口咽通气管组[（36.45±17.53）mmHg vs.（48.56±9.62）mmHg，P=0.009]二氧化碳分压低于对照组。 结论 重症卒中早期给予口咽通气管或鼻咽通气管开放气道能改善呼吸道不畅，提高血氧分压、降低二氧化碳潴留。但鼻咽通气管与口咽通气管相比，可减少卒中后误吸的发生，降低肺部感染概率，延缓气管插管转化时间，降低气管插管转化率，缩短住院时间。 Abstract: Objective To study the clinical effects of early oropharyngeal ventilation tube or nasopharyngeal ventilation tube in patients with severe stroke. Methods The consecutive patients with severe stroke admitted to the emergency room of Beijing Tiantan Hospital, Capital Medical University from June 2020 to June 2022 were included in the study. Patients were divided into oropharyngeal airway group, nasopharyngeal airway group and control group according to the use of oropharyngeal airway, nasopharyngeal airway, and non-use of oral/nasopharyngeal airway. Their clinical data were collected. The clinical features, incidence of pulmonary infection within 7 days after admission, conversion rate and time of sequent tracheal intubation were compared among all groups. Results A total of 213 patients with severe stroke were included, including 123 males (57.7%), 119 cases of cerebral hemorrhage and 94 cases of cerebral infarction. There were 68 cases in oropharyngeal airway group, 79 cases in nasopharyngeal airway group, and 66 cases in control group. The incidence of aspiration in nasopharyngeal airway group was lower than that in the control group (10.13% vs. 19.70%, P=0.034) and oropharyngeal airway group (10.13% vs. 22.06%, P=0.021). The incidence of pulmonary infection within 7 days after admission in nasopharyngeal airway group was lower than that in control group (32.91% vs. 59.09%, P=0.018) and oropharyngeal airway group (32.91% vs. 45.59%, P=0.023). There was no statistical difference in in-hospital all-cause mortality (30.38% vs. 32.35% vs. 34.84%, P=0.660) among the three groups within 7 days after admission. The conversion rate of endotracheal intubation in nasopharyngeal airway group was lower than that in oropharyngeal airway group (12.66% vs. 44.12% P=0.022) and control group (12.66% vs. 43.94%, P=0.031). The conversion time of endotracheal intubation in nasopharyngeal airway group delayed compared to that in oropharyngeal airway group [(6.72± 2.15) d vs. (4.12±1.23) d, P=0.022] and control group [(6.72±2.15) d vs. (3.12±1.33) d, P=0.011]. Blood gas analysis at 7 days after admission showed that the blood oxygen partial pressure of nasopharyngeal airway group [(83.56±8.31) mmHg vs. (76.34±8.63) mmHg, P=0.007] and oropharyngeal airway group [(84.56±5.84) mmHg vs. (76.34±8.63) mmHg, P=0.003] was higher than that of the control group, while the carbon dioxide partial pressure of nasopharyngeal airway group [(37.67±11.22) mmHg vs. (48.56±9.62) mmHg, P=0.012] and oropharyngeal airway group [(36.45±17.53) mmHg vs. (48.56±9.62) mmHg, P=0.009] was lower than that in control group. Conclusions In the early stage of severe stroke, oropharyngeal ventilation tube or nasopharyngeal ventilation tube can improve airway obstruction, increase blood oxygen partial pressure and reduce carbon dioxide retention. However, compared with oropharyngeal ventilation tube, nasopharyngeal ventilation tube can reduce the occurrence of aspiration after stroke, reduce the risk of pulmonary infection, delay the conversion time of endotracheal intubation, reduce the conversion rate of endotracheal intubation, and shorten the length of hospital stay.
Keywords
