1Department of Neurological Surgery.
2College of Medicine.
J Neurosurg. 2020 Jan 1;132(1):87-93. doi: 10.3171/2018.7.JNS181345. Epub 2019 Jan 4.
Existing literature supports benefits of early tracheostomy and percutaneous endoscopic gastrostomy (PEG) in certain patient populations. The aim of this study was to review tracheostomy and PEG placement data in patients with hemorrhagic stroke in order to identify factors associated with earlier placement and to evaluate outcomes.
The authors performed a retrospective review of consecutive patients treated for hemorrhagic stroke between June 1, 2011, and June 1, 2015. Data were analyzed by logistic and multiple linear regression.
Of 240 patients diagnosed with hemorrhagic stroke, 31.25% underwent tracheostomy and 35.83% underwent PEG tube placement. Factors significantly associated with tracheostomy and PEG included the presence of pneumonia on admission and subarachnoid hemorrhage. Earlier tracheostomy was significantly associated with shorter ICU length of stay; earlier tracheostomy and PEG placement were associated with shorter overall hospitalization. Timing of tracheostomy and PEG was not significantly associated with patient survival or the incidence of complications in this population.
This study identified patient risk factors associated with increased likelihood of tracheostomy and PEG in patients with hemorrhagic stroke who were critically ill. Additionally, we found that the timing of tracheostomy was associated with length of ICU stay and overall hospital stay, and that the timing of PEG was associated with overall length of hospitalization. Complication rates related to tracheostomy and PEG in this population were minimal. This retrospective data set supports some benefit to earlier tracheostomy and PEG placement in this population and justifies the need for further prospective study.
现有文献支持在某些特定患者群体中尽早行气管切开术和经皮内镜下胃造瘘术（PEG）。本研究旨在回顾分析出血性脑卒中患者行气管切开术和 PEG 置管的数据，以确定与更早置管相关的因素，并评估其结局。
作者对 2011 年 6 月 1 日至 2015 年 6 月 1 日期间连续收治的出血性脑卒中患者进行了回顾性分析。采用逻辑回归和多元线性回归分析数据。
在 240 例诊断为出血性脑卒中的患者中，31.25%的患者行气管切开术，35.83%的患者行 PEG 管置管术。与气管切开术和 PEG 相关的显著因素包括入院时肺炎和蛛网膜下腔出血的存在。更早的气管切开术与 ICU 住院时间缩短显著相关；更早的气管切开术和 PEG 置管与总住院时间缩短相关。在该人群中，气管切开术和 PEG 置管的时机与患者生存率或并发症发生率无显著相关性。
本研究确定了与危重出血性脑卒中患者行气管切开术和 PEG 相关的患者风险因素。此外，我们发现气管切开术的时机与 ICU 住院时间和总住院时间有关，PEG 的时机与总住院时间有关。该人群中与气管切开术和 PEG 相关的并发症发生率较低。本回顾性数据集支持在该人群中尽早行气管切开术和 PEG 置管具有一定的益处，并证明了进一步进行前瞻性研究的必要性。
