预防性气管切开术对长期卧床老年病人吸入性肺炎发生率及病死率的影响
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摘要
目的观察床旁预防性经皮扩张气管切开术(protective percutaneous dilation tracheotomy,PPDT)对长期卧床老年病人吸入性肺炎发生率及其病死率的影响。方法采用开放对照前瞻性研究方法,选择168例长期卧床行PPDT(PPDT组)的老年病人,同时选择174例病因基本相同,长期卧床非气管切开老年病人为对照(对照组),比较短期、长期吸入性肺炎发生率与病死率的差异。结果 PPDT组短期、长期吸入性肺炎月均发生率显著低于对照组(32.1%比93.1%P<0.001;24.4%比78.1%P<0.001)。PPDT组短期、长期病死率分别为7.7%、9.6%,对照组分别为20.6%、25.3%,2组比较差异均有统计学意义(P均<0.05)。结论 PPDT能有效减少长期卧床老年病人吸入性肺炎的发生,降低其死亡风险。
Objective To observe the influences of bedside protective percutaneous dilation tracheotomy(PPDT) on morbidity of aspiration pneumonia and mortality in the long-term bed elderly patients.Methods An open control prospective study was carried out.168 long-term bed elderly patients received bedside PPDT(PPDT group).The morbidity of aspiration pneumonia and the mortality of the patients after PPDT for short term(one month) and long term(one year) were observed.The clinical data of 174 patients who did not receive PPDT(control group) were also analyzed.Results The short-term and long-term morbidity rate of aspiration pneumonia in PPDT group were significantly lower than those in control group(32.1% vs 93.1%,24.4% vs 78.1% P<0.001),as well as the mortality(7.7% vs 20.6%P = 0.010;9.6% vs 23.5% P = 0.014).Conclusions The bedside PPDT could effectively prevent aspiration pneumonia and decrease the risk of death in the long-term bed elderly patients.
Objective To observe the influences of bedside protective percutaneous dilation tracheotomy(PPDT) on morbidity of aspiration pneumonia and mortality in the long-term bed elderly patients.Methods An open control prospective study was carried out.168 long-term bed elderly patients received bedside PPDT(PPDT group).The morbidity of aspiration pneumonia and the mortality of the patients after PPDT for short term(one month) and long term(one year) were observed.The clinical data of 174 patients who did not receive PPDT(control group) were also analyzed.Results The short-term and long-term morbidity rate of aspiration pneumonia in PPDT group were significantly lower than those in control group(32.1% vs 93.1%,24.4% vs 78.1% P<0.001),as well as the mortality(7.7% vs 20.6%P = 0.010;9.6% vs 23.5% P = 0.014).Conclusions The bedside PPDT could effectively prevent aspiration pneumonia and decrease the risk of death in the long-term bed elderly patients.
引文
[1]安德明,程秀丽,荣淑梅.气管切开术在治疗及抢救老年患者中的应用(附128例分析)[J].中国老年学杂志,1996,16(4):222-223.
[2]Goldenberg D,Golz A,Huri A.Percutaneous dilation tracheotomy versus surgical tracheotomy:our experience[J].Otolaryngol Head Neck Surg,2003,128(3):358-363.
[3]中华医学会呼吸病分会.医院获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,1999,22(4):201-203.
[4]Meacham R,Vieira F.Is obesity truly a risk factor for mortality after tracheotomy?[J].Ann Otol Rhinol Laryngol,2012,121(11):733-737.
[5]Akio Tada,Hiroko Miura.Prevention of aspiration pneumonia(AP)with oral care[J].Arch Gerontol Geria,2012,55(1):16-21.
[6]Wierzbicka M,Pastusiak T,Stryjakowska K,et al.Tracheotomy as a bedside procedure in the Intensive Care Unit:is it safe?[J].Otolaryngol Pol,2007,61(4):404-408.
[7]Miyake N,Kawamoto K,Fujiwara K,et al.Subglottic laryngeal closure:a unique modified method of laryngotracheal separation to prevent aspiration[J].Ann Otol Rhinol Laryngol,2013,122(7):427-434.
[8]谭清武.80岁以上老年肺部感染并发多器官功能不全死亡的影响因素研究[J].实用老年医学,2015,29(11):899-901.
[2]Goldenberg D,Golz A,Huri A.Percutaneous dilation tracheotomy versus surgical tracheotomy:our experience[J].Otolaryngol Head Neck Surg,2003,128(3):358-363.
[3]中华医学会呼吸病分会.医院获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,1999,22(4):201-203.
[4]Meacham R,Vieira F.Is obesity truly a risk factor for mortality after tracheotomy?[J].Ann Otol Rhinol Laryngol,2012,121(11):733-737.
[5]Akio Tada,Hiroko Miura.Prevention of aspiration pneumonia(AP)with oral care[J].Arch Gerontol Geria,2012,55(1):16-21.
[6]Wierzbicka M,Pastusiak T,Stryjakowska K,et al.Tracheotomy as a bedside procedure in the Intensive Care Unit:is it safe?[J].Otolaryngol Pol,2007,61(4):404-408.
[7]Miyake N,Kawamoto K,Fujiwara K,et al.Subglottic laryngeal closure:a unique modified method of laryngotracheal separation to prevent aspiration[J].Ann Otol Rhinol Laryngol,2013,122(7):427-434.
[8]谭清武.80岁以上老年肺部感染并发多器官功能不全死亡的影响因素研究[J].实用老年医学,2015,29(11):899-901.