自主咳嗽对ICU住院颅脑外伤患者拔管效果的预测价值

目的：探讨自主咳嗽次数对IC U住院颅脑外伤患者拔管效果的预测价值。方法青海省第五人民医院IC U 收治的重型颅脑损伤经人工气道管理患者78例，根据拔管成功与否分为成功组（53例）和失败组（25例）。经患者知情同意后，登记一般资料，同时记录拔管前格拉斯哥昏迷评分（GCS ）总分和自主咳嗽次数情况。结果患者拔管成功53例，失败25例，失败率为32．05％。两组年龄、性别、既往病史、住院获得性肺炎、疾病种类及插管时间比较，差异无统计学意义（P＞0．05），而在吸烟、BMI、GCS总分和自主咳嗽次数差异有统计学意义（P＜0．05）。两组患者撤机参数比较差异均无统计学意义（P＞0．05）。GCS曲线下面积（AUC）为0．822，BMI AUC为0．674，自主咳嗽次数AUC为0．914，吸烟AUC为0．856。结论吸烟、BMI、GCS和自主咳嗽次数均可用来评估颅脑损伤患者的拔管时机，其中自主咳嗽次数准确度最高，是拔管成功的重要预测因素。

Predictive value of spontaneous cough in extubation patients with craniocerebral injury in ICU

Objective To investigate the predictive value of spontaneous cough in extubation patients with craniocerebral in‐jury in ICU .Methods Totally 78 cases of patients with severe craniocerebral injury in ICU was divided into successful exbuation group (53 cases) and failing exbuation group (25 cases) according to the exbuation outcome .With the permission of patients ,the general clinical data ,glasgow coma scale (GCS) scores and spontaneous cough of patients were recorded .Results There were 53 cases suceed ;25 cases of patients failing in exbuation ,accounting for 32 .05% .There were no significant difference between ages , gender ,medical history ,hospital acquired pneumonia (HAP) ,disease kind between two groups (P> 0 .05) ,while had significant difference between smoking ,body mass index (BMI)、GCS scores and spontaneous cough of two groups (P<0 .05) .No significant difference was found between the conventional exbuation parameter of two groups (P> 0 .05) .Receiver operating characteristic curve (ROC) analysis showed that ,GCS scoresarea under the curve (AUC) was 0 .822 ,BMI AUC was 0 .674 ,spontaneous cough AUC was 0 .914 ,and smoking AUC was 0 .856 .Conclusion Smoking ,BMI and GCS scores and spontaneous cough times were all meaningful indices for evaluating exbuation of patients with craniocerebral injury in ICU ,in which spontaneous cough times was an important predictive factor and the most accurate one .