Grotta J, Pasteur W, Khwaja G, Hamel T, Fisher M, Ramirez A
Department of Neurology, University of Texas Medical School, Houston, USA.
Neurology. 1995 Apr;45(4):640-4. doi: 10.1212/wnl.45.4.640.
To provide data to guide physicians and family when deciding whether a patient should be electively intubated after ischemic stroke.
Chart review and patient interview. Clinical course, neurologic outcome, and financial and psychosocial effect of the decision to intubate were determined.
Neurology/Neurosurgery critical care unit.
Of our last 250 acute carotid territory ischemic stroke cases, we found 20 patients (8%) who were electively intubated, after CT and neurologic assessment, for neurologic deterioration.
All patients received standard medical therapy.
Intubation occurred 3 hours to 7 days (mean, 41 hours) after the onset of symptoms; six of 20 patients required intubation within the first 6 hours. Once clinical deterioration began, 10 of 20 patients required intubation within 1 hour. Six of 20 patients were discharged alive; two subsequently died, one is mostly dependent, two became mostly independent (one of these had a hemicraniectomy and is still improving, and the other died of an intercurrent illness 4 years after her stroke), and one is totally independent. The four "good" outcome survivors were distinguished by higher Glasgow Coma Scale scores (9.2 versus 5.9), and extubation was usually possible within 72 hours. For nonsurvivors, mean hospitalization after intubation was 6.4 days. In survivors, the monthly uninsured cost was $0 to $2,000, and caregivers experienced moderate stress. The same decision would be repeated by 76% of caregivers; 53% of caregivers would want intubation for themselves.
Satisfactory outcome is possible in the 8% of ischemic stroke patients requiring elective intubation. Possible predictors of good outcome include less severe depression of consciousness at the time of intubation, extubation within 3 days, and hemicraniectomy. In retrospect, most families would repeat the decision to intubate. Further study in more patients of the cost/benefit of cerebral resuscitation after stroke is greatly needed.
提供数据，以指导医生和家属在决定缺血性中风患者是否应进行选择性插管时做出决策。
病历审查和患者访谈。确定插管决策的临床过程、神经学结果以及财务和社会心理影响。
神经内科/神经外科重症监护病房。
在我们最近的250例急性颈动脉供血区缺血性中风病例中，我们发现20例患者（8%）在CT和神经学评估后因神经功能恶化而接受了选择性插管。
所有患者均接受标准药物治疗。
插管发生在症状出现后3小时至7天（平均41小时）；20例患者中有6例在最初6小时内需要插管。一旦临床恶化开始，20例患者中有10例在1小时内需要插管。20例患者中有6例存活出院；2例随后死亡，1例大部分依赖他人照顾，2例大部分能够自理（其中1例接受了去骨瓣减压术且仍在恢复中，另1例在中风后4年死于并发疾病），1例完全自理。4例“良好”结局幸存者的格拉斯哥昏迷量表评分较高（9.2比5.9），通常在72小时内可以拔管。对于非幸存者，插管后的平均住院时间为6.4天。在幸存者中，每月未保险费用为0至2000美元，照顾者承受中度压力。76%的照顾者会重复相同的决策；53%的照顾者希望自己接受插管。
在8%需要选择性插管的缺血性中风患者中，可能会有令人满意的结局。良好结局的可能预测因素包括插管时意识障碍较轻、3天内拔管以及去骨瓣减压术。回顾来看，大多数家属会重复插管的决定。非常需要对更多患者进行中风后脑复苏成本效益的进一步研究。
