Tuna Bilge, Birdane Leman
Department of Otorhinolaryngology, Bursa City Hospital, Doğanköy Nilüfer, 16110 Bursa, Turkey.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3016-3021. doi: 10.1007/s12070-021-02717-3. Epub 2021 Jul 6.
The role of tracheotomy during the pandemic remains to be determined for severe COVID-19 pneumonia. We evaluated the effect of tracheotomy on prognostic markers and assessed 4 weeks survival in terms of clinical and biochemical characteristics of patients and time and type (open or percutaneous) of the operation. We performed a retrospective study considering ICU patients with COVID-19 pneumonia and tracheotomy, between May 30 and December 31, 2020. Four weeks survival postoperatively and alteration of biochemical markers were analyzed. 24 patients with COVID-19 pneumonia and tracheotomy, included in this study. Median age was 68.3 years (range 38-90) with male:female ratio 16:8. All the patients were diagnosed with COVID-19 pneumonia considering clinical symptoms and COVID-19 specific CT findings. RT-PCR test results were positive in 58.3%. Prognostic markers were found to be increased postoperatively with both types of surgery (75%). 1 week and 4 weeks survival after the operation was 66.7% and 45.8%, respectively. 4 weeks survival was decreased significantly with NLR ≥ 10 compared to NLR < 10 (15.3-81.8%). Nevertheless, 4 weeks survival differences between males and females (12.5% and 62.5%) and between age ≤ 50 and > 50 (100% and 35%) were also found to be statistically significant. Patients with younger age, male gender, and NLR < 10, were found to have longer survival after tracheotomy. Positive PCR results and preoperative critically increased biochemical markers were related to decreased survival. The number of comorbidities, time and type of surgery, and postoperative increment of prognostic markers seemed not to affect survival.
对于重症新型冠状病毒肺炎，气管切开术在疫情期间的作用仍有待确定。我们评估了气管切开术对预后标志物的影响，并根据患者的临床和生化特征、手术时间及类型（开放或经皮）评估了4周生存率。我们对2020年5月30日至12月31日期间入住重症监护病房且接受气管切开术的新型冠状病毒肺炎患者进行了一项回顾性研究。分析了术后4周生存率及生化标志物的变化。本研究纳入了24例接受气管切开术的新型冠状病毒肺炎患者。中位年龄为68.3岁（范围38 - 90岁），男女比例为16:8。所有患者均根据临床症状和新型冠状病毒肺炎特异性CT表现确诊为新型冠状病毒肺炎。逆转录聚合酶链反应（RT-PCR）检测结果阳性率为58.3%。发现两种手术方式术后预后标志物均升高（75%）。术后1周和4周生存率分别为66.7%和45.8%。与中性粒细胞与淋巴细胞比值（NLR）<10相比，NLR≥10时4周生存率显著降低（15.3% - 81.8%）。然而，男性和女性之间（12.5%和62.5%）以及年龄≤50岁和>50岁之间（100%和35%）的4周生存率差异也具有统计学意义。年龄较小、男性且NLR<10的患者气管切开术后生存时间更长。PCR结果阳性和术前生化标志物显著升高与生存率降低有关。合并症数量、手术时间和类型以及术后预后标志物的升高似乎不影响生存率。
