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目的探讨早期气管切开在急、危重病人的临床作用。方法对近5年217例 ICU 急、危重症需气管切开和机械通气的病人进行回顾性分析,分别对早期气管切开(ET,手术在发病3 d 内施行)与延期气管切开(LT,手术在发病7 d 后施行)病人的 APACHEⅡ评分、机械通气天数、住 ICU 和总住院时间、呼吸机相关肺炎(VAP)发生率、死亡率和手术早期并发症发生率进行分析比较。结果在 LT 组 VAP 发生率显著升高,机械通气时间明显延长;在 ET 组病人住 ICU 和总住院时间明显缩短。结论早期气管切开对急、危重病人有较高的临床价值,如能在3 d 内施行气管切开能够显著降低病人 VAP 发生率,减少机械通气时间,缩短住 ICU 和总住院时间。
Objective To investigate the clinical effect of early tracheotomy in acute and critically ill patients. Methods A retrospective analysis was performed on 217 tracheotomy and mechanical ventilation patients in acute and critical ICU in the recent 5 years. The data of early tracheotomy (ET, operation within 3 days of onset) and delayed tracheotomy APACHEⅡscore, days of mechanical ventilation, ICU and total length of hospital stay, incidence of ventilator-associated pneumonia (VAP), mortality and early complications of surgery were compared and analyzed. Results The incidence of VAP was significantly increased in LT group and the duration of mechanical ventilation was significantly prolonged. The ICU and total length of stay in patients with ET were significantly shorter. Conclusions Early tracheotomy has high clinical value for acute and critically ill patients. If tracheotomy can be performed within 3 days, the incidence of VAP can be significantly decreased, the duration of mechanical ventilation and ICU and the total length of stay can be shortened.