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目的：评估早期经皮气管切开（percutaneous dilational tracheotomy, PDT）对重型脑血管意外患者的影响。方法：对我院2007 年5 月至2012 年12 月采用PDT 行气管切开的87 例重型脑血管意外患者进行回顾性分析。根据经口插管机械通气（mechanical ventilation, MV）时间将患者分成早期气管切开组(≤ 7d Early tracheotomy, ET)共42 例，晚期气管切开组(>7 d Late tracheotomy, LT)共45 例，其中ET 组男性23例，平均年龄41.36± 14.12 岁，LT 组男性26 例，平均年龄46.38± 13.87 岁。观察两组患者的一般情况、经口插管MV 时间、PDT 后MV 时间、PDT 后住重症医学科（intensive care unit, ICU）时间、总住院时间、28d病死率和呼吸机相关性肺炎(ventilator-associated pneumonia ,VAP)发生率等。结果：两组患者在一般情况如年龄、性别、急性生理学和慢性健康状况(Acute physiology and chronic health evaluation II ,APACHEII)评分以及格拉斯哥昏迷(Glasgow coma scale ,GCS)评分比较,差异均无统计学意义(P 均>0.05)，ET 组显著缩短了经口插管MV 时间、PDT 后MV 时间、PDT 后住ICU 时间，差异均有统计学意义 (P 均<0.05)，但两组在总住院时间、28d病死率和VAP 发生率比较，差异均无统计学意义(P 均>0.05)。结论：虽然ET不影响患者预后及VAP 发生率，但可缩短患者经口插管MV 时间、PDT 后MV 时间、PDT 后住ICU 时间，故对于重型脑血管意外患者应采取早期PDT。

英文摘要:

Objective: To examine the impact of early percutaneous dilational tracheotomy (PDT) in patient with severe cerebrovascular accident.Methods:A total of 87 patients with severe cerebrovascular accident underwent PDT from May 2007 to December 2012, were retrospectively studied. According to the length of endotracheal intubation with mechanical ventilation (MV) , the patients will be divided into two groups: early tracheotomy group (≤ 7d Early tracheotomy, ET) of 42 cases, and late tracheotomy group (>7 d Late tracheotomy, LT) of 45 cases. The general of the two groups of patients, endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay, the length of stay in hospital, 28d mortality and the incidence of ventilator-associated pneumonia (VAP) were compared between the two groups.Results:No differences were found in general, such as age, gender, Acute physiology and chronic health evaluation II (APACHEII) score and Glasgow coma scale (GCS) score between the two groups (all P > 0.05). Endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay were significant shorter in the ET group (P <0.05). But the length of stay in hospital, 28d mortality and the incidence of VAP showed no different between the two groups (P > 0.05).Conclusion:Although ET does not shorten the length of stay in hospital, 28d mortality and the incidence of VAP, it may shorten endotracheal intubation-MV days, MV periods after PDT, post-PDT ICU stay, so early percutaneous dilational tracheotomy should be adopted in patient with severe cerebrovascular accident.

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