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黄丛萍,倪莹莹,章良翔,吕 晓,燕铁斌,邓碟霞,李 芳,刘飞平,陈文香.持续植物状态气管切开插管两种拔管方式的对照研究[J].中国康复医学杂志,2017,(7):798~801
持续植物状态气管切开插管两种拔管方式的对照研究    点此下载全文
黄丛萍  倪莹莹  章良翔  吕 晓  燕铁斌  邓碟霞  李 芳  刘飞平  陈文香
广东三九脑科医院,广州,510510
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DOI:
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摘要:
      摘要 目的:比较持续植物状态(PVS)气管切开插管患者两种不同拔管方式(封拔法和换封拔法)的效果。 方法:我院植物状态促醒中心(123例)入组PVS气管切开插管患者随机分为封拔2步法组、换封拔3步法组。封拔2步法组使用自制封管套封管全封堵48h后,如果呼吸正常者直接拔出套管。换封拔3步法组先更换金属套管1周后,封管24—48h,如果呼吸正常者则拔出套管。记录从封管至拔管过程中患者心率、呼吸、血氧饱和度变化以及不同性别、病程、气管套管留置时间、拔管时间、拔管成功率及并发症的发生率。 结果:①两组拔管时间比较,封拔2步法组拔管时间明显短于换封拔3步法组(P=0.034);两组患者病程为4—12周,比较差异更明显(P<0.05);脑外伤、高血压脑出血患者拔管时间比较,封拔2步法组的拔管时间也明显短于换封拔3步法组(P<0.05)。②两组拔管成功率、并发症发生率比较无显著性差异(P>0.05)。 结论:两种拔管方式的安全性、成功率、并发症发生率相同,但封拔2步法的拔管时间较短,特别是病程为4—12周、病因为脑外伤与高血压脑出血者,更加短于换封拔3步法。
关键词:持续植物状态  气管切开  气管套管  拔管
Comparative study of two methods of tracheal extubation for persistent vegetative state with tracheotomy and intubation    Download Fulltext
Guangdong 999 Brain Hospital,No.578,Shatainan Road,Baiyun District, Guangzhou City,Guangdong Prov,510510
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Abstract:
      Abstract Objective: To compare the effects of two methods of tracheal extubation for persistent vegetative state (PVS) with tracheotomy and intubation. Method: One hundred and twenty-three PVS patients with tracheotomy and intubation were recruited from Guangdong 999 Brain Hospital. They were randomly assigned to observation group and control group. Observation group was given self-made sealing sleeve to plug the endotracheal intubation completely. If patients breathed normally in 48 hours, the tracheotomy cannulas would be extubated. Control group was replaced with metal tracheal cannulas that would be plugged directly after 1 week. If breathing normally in 48 hours, patients would be given extubation. The heart rate, respiration, blood oxygen saturation and different gender, the course of disease, the tracheal tube indwelling time, extubation time, extubation success rate and complication rates of two groups were recorded. Result: Extubation time: ①The difference in extubation time between the two groups was statistically significant (P<0.05); ②When the course of disease was 4—12 weeks, the difference of extubation time was more obvious(P<0.05); ③For the patients with traumatic brain injury or cerebral hemorrhage, extubation time also showed more obvious difference(P<0.05). For extubation success rate and complication rates, there was no statistical difference between the two groups (P>0.05). Conclusion: There was no statistical difference in safety, success rate, complication rate between two groups. At the same time, observation group had the shorter extubation time, especially in the patients with 4—12 weeks of course of disease, or with traumatic brain injury, cerebral hemorrhage or ischemia anoxic encephalopathy.
Keywords:persistent vegetative state  tracheotomy  tracheal cannula  tracheal extubation
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