鄢永安

【摘要】 目的：研究气管切开术对老年多脏器衰竭患者抢救效率及预后的影响。方法：选取本院2015年2月-2017年5月收治的老年多脏器衰竭并行抢救的患者70例作为研究对象，按其是否使用气管切开术分为对照组（n=35）和观察组（n=35）。对照组不进行气管切开术，观察组在抢救过程中使用气管切开术，比较两组抢救有效情况、治疗前后的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）和快速序贯器官衰竭（qSOFA）评分以及家属满意度情况。结果：观察组抢救有效率为68.57%明显高于对照组的42.86%，差异有统计学意义（字2=4.690，P=0.030）。治疗前两组APACHEⅡ及qSOFA评分比较，差异均无统计学意义（P>0.05）；治疗后，观察组APACHEⅡ及qSOFA评分均明显低于对照组，差异均有统计学意义（P<0.05）。观察组家属满意度明显高于对照组，差异有统计学意义（字2=4.768，P=0.029）。结论：对老年多脏器衰竭患者抢救过程中进行气管切开术能有效提高抢救有效率，改善患者预后，值得临床推广。

【关键词】 气管切开术； 多脏器衰竭； 抢救效率； 预后

【Abstract】 Objective：To study the effect of tracheotomy on the rescue efficiency and prognosis of elderly patients with multiple organ failure.Method：A total of 70 elderly patients with multiple organ failures treated in our hospital from February 2015 to May 2017 were selected as the study objects.According to whether tracheotomy was used，they were divided into control group （n=35） and observation group （n=35）.The control group was not used tracheotomy，the observation group was used tracheotomy during the rescue process.The rescue effectiveness， acute physiology and chronic health status score system Ⅱ（APACHEⅡ） and rapid sequential organ failure （qSOFA） scores before and after treatment and family satisfaction between the two groups were compared.Result：The effective rate of the observation group was 68.57%，which was significantly higher than 42.86% of the control group，the difference was statistically significant （字2=4.690，P=0.030）.There were no significant differences in APACHEⅡ and qSOFA scores between the two groups before treatment （P>0.05）；after treatment，the APACHEⅡ and qSOFA scores in the observation group were significantly lower than those in the control group，the differences were statistically significant （P<0.05）.The family satisfaction of the observation group was significantly higher than that of the control group，the difference was statistically significant （字2=4.768，P=0.029）.Conclusion：Tracheotomy for elderly patients with multiple organ failure during the rescue process can effectively improve the rescue efficiency and the prognosis of patients， which is worthy of clinical promotion.

【Key words】 Tracheotomy； Multiple organ failure； Rescue efficiency； Prognosis

First-authors address：Affiliated Hospital of Jinggangshan University，Jian 343000，China

doi：10.3969/j.issn.1674-4985.2018.32.037

隨着我国人口老龄化进程的加快，由于老年人器官老化、多伴有慢性疾病等原因，一旦受到严重感染、创伤、大手术等影响，极易在短时间内同时或连续发生2个及以上脏器衰竭，其病情表现复杂，预后极差，且有极高致死率，严重危害老年患者生命安全[1-2]。多脏器衰竭（multiple organ failure，MOF）亦称多系统器官功能衰竭（multiple systemic organ failure，MSOF），患者常伴有气道梗阻、呼吸循环功能障碍等严重并发症，急需紧急呼吸支持，气管切开术则能有效解除气道梗阻，改善患者呼吸功能。各类研究报道指出，其在重症患者抢救中已达到广泛应用[3-4]。但其用于老年MOF患者中相关文献较少，笔者就此进行研究，对本院近年抢救的老年MOF患者的临床资料进行分析，并得出结论，现将研究结果报道如下。