气管切开与经鼻插管救治重症破伤风致呼吸衰竭患者的疗效比较

目的 探讨气管切开与经鼻气管插管人工气道建立在重症破伤风致呼吸衰竭患者救治中的应用效果.方法 采用回顾性病例对照研究分析2012年1月至2019年12月江西省胸科医院院收治的92例重症破伤风呼吸衰竭患者临床资料,其中男60例,女32例;年龄23～81岁[(47.5± 14.1)岁].43例行气管切开(气管切开组),49...

Efficacy comparison of tracheotomy and transnasal intubation in treatment of severe tetanus patients with respiratory failure

Objective To explore the efficacy of tracheotomy and nasal intubation in airwaysmanagement in treatment of patients with respiratory failure caused by severe tetanus.Methods A respectivecase series study was conducted to analyze the data of 92 patients with respiratory failure caused by severetetanus admitted to Jiangxi Chest Hospital from January 2012 to December 2019.There were 60 malesand 32 females,aged 23-81 years[(47.5±14.l)years].Overall 43 patients underwent tracheotomy(tracheotomy group),and 49 patients underwent nasal intubation(nasal intubation group).The bloodgas relaterd indexes(PaO,,PaCO),catheter retention time,incidence of complications such as airwaybleeding,nasosinusitis,catheter blockage and ventilator-associated pneumonia(VAP),and clinicaloutcome were compared between the two groups.Results After mechanical ventilation,the PaO,andPaCOin both groups wcrc significantly improvcd(P<0.01),with no significant difference between groups(P>0.05).Both groups were sinmilar regarding the catheter indwelling time,catheter blockage,airway bleeding and nasosinusitis(P>0.05).The incidences of VAP and catheter blockage afterextubation in tracheotomy group[12%(5/43),12%(5/43)]were significantly different from those innasal intubation group[0%(0/49),31%(15/49)](P<0.05).There were 3 deaths in each group,with the mortality rate of 7%(3/43)in tracheotomy group and of 6%(3/49)in nasal intubation group(P>0.05).Both groups of live tetanus patients were cured.After 3-month follow-up,the tetanus wascured in the two groups.ConclusionsThe tracheotomy and transnasal tracheal intubation are optionalfor severe tetanus patients with respiratory failure.The former has airway and tissue trauma,but it isconvenient for mechanical ventilation management,especialy indicated for patients with severeconvulsions,angular arch reflexes,poor sedation,and continuous application of muscle relaxants,Nasalintubation is relatively non-invasive,simple and fast method,but the prevention and monitoring of VAPrequires higher requirements.