Guo Chutong, Ye Heng, Chen Xinglin, Luo Yuting, Wu Shaoqing, Sun Xunsha
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
BMC Neurol. 2025 Jul 2;25(1):273. doi: 10.1186/s12883-025-04275-5.
Tracheostomy is frequently performed in severe ischemic stroke patients, yet the ideal timing for this procedure remains undefined. This study seeks to inform clinical decisions by evaluating the impact of early versus standard tracheostomy on clinical outcomes in this patient population.
We retrospectively reviewed severe ischemic stroke patients who underwent tracheostomy at our hospital between January 2013 and November 2023. Patients were categorized into early tracheostomy (ET) and standard tracheostomy (ST) groups based on the interval from intubation to tracheostomy. Clinical outcomes were compared between the two groups. The logistic regression model was used to assess the correlation between the timing of tracheostomy and outcomes, and the Kaplan-Meier method was employed to analyze time-to-event results.
The study encompassed 110 patients, with 57 in the ET group and 53 in the ST group. The results showed that the ET group had a longer interval from onset to intubation (P = 0.048), but there was no significant difference in the proportion of patients with severe disability after six months (OR 1.089 [95% CI 0.377-3.144], aOR 1.091 [95% CI 0.345-3.447]). The ET group demonstrated a shorter mechanical ventilation time (aOR 1.036 [95%CI 1.005-1.069]) and a decreased incidence of tracheostomy-related complications (aOR 5.378 [95%CI 1.065-27.144]).
Early tracheostomy does not affect the long-term outcomes of patients with severe ischemic stroke, but it may offer potential benefits.
气管切开术在重度缺血性中风患者中经常进行，但该手术的理想时机仍不明确。本研究旨在通过评估早期气管切开术与标准气管切开术对该患者群体临床结局的影响，为临床决策提供依据。
我们回顾性分析了2013年1月至2023年11月在我院接受气管切开术的重度缺血性中风患者。根据从插管到气管切开的时间间隔，将患者分为早期气管切开术（ET）组和标准气管切开术（ST）组。比较两组的临床结局。采用逻辑回归模型评估气管切开术时机与结局之间的相关性，并采用Kaplan-Meier方法分析事件发生时间结果。
该研究纳入了110例患者，其中ET组57例，ST组53例。结果显示，ET组从发病到插管的时间间隔更长（P = 0.048），但六个月后重度残疾患者的比例无显著差异（OR 1.089 [95%CI 0.377 - 3.144]，aOR 1.091 [95%CI 0.345 - 3.447]）。ET组的机械通气时间较短（aOR 1.036 [95%CI 1.005 - 1.069]），气管切开术相关并发症的发生率降低（aOR 5.378 [95%CI 1.065 - 27.144]）。
早期气管切开术不影响重度缺血性中风患者的长期结局，但可能具有潜在益处。
