Schneider Hauke, Hertel Franziska, Kuhn Matthias, Ragaller Maximilian, Gottschlich Birgit, Trabitzsch Anne, Dengl Markus, Neudert Marcus, Reichmann Heinz, Wöpking Sigrid
Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany.
Neurocrit Care. 2017 Aug;27(1):26-34. doi: 10.1007/s12028-017-0390-y.
Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients.
A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation.
We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]).
Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
对于因持续严重吞咽困难、意识水平降低或机械通气时间延长而接受通气治疗的中风患者，需行气管切开术。本研究的目的是确定气管切开术后中风患者成功拔管的频率和预测因素以及长期功能结局。
一项前瞻性单中心观察性研究纳入了患有缺血性中风、脑出血和蛛网膜下腔出血的通气患者。在出院时、3个月和12个月进行随访。进行竞争风险分析以确定拔管的预测因素。
我们纳入了53例接受气管切开术的通气中风患者。气管切开术后一年，19例患者拔管（拔管的中位[IQR]时间为74[58 - 117]天），13例患者永久带管，21例患者未事先拔管即死亡。我们队列中拔管的独立预测因素为患者年龄（每增加一岁，HR为0.95[95%CI：0.92 - 0.99]，p = 0.003）和无脓毒症（HR为4.44[95%CI：1.33 - 14.80]，p = 0.008）。与存活但未拔管的患者相比，拔管患者一年后的功能结局有所改善（改良Rankin量表中位评分4比5[p < 0.001]；Barthel指数中位评分35比5[p < 0.001]）。
气管切开术后存活前12个月的中风患者中有59.4%实现了拔管，与未拔管的患者相比，功能结局更好。需要进一步开展更大样本量的前瞻性研究来证实我们的结果。
