- 期刊
Risk Factors for Tracheostomy Infection in Ventilator-dependent Patients
使用呼吸器且接受氣管切開術的病人其發生氣切傷口感染的危險因子之探討
摘要
氣管切開術在呼吸器依賴的病人是一種常見的手術方式，因氣切手術引起的傷口感染比率各家報告皆有差異，本研究將探討氣切手術前後病患的臨床特徵與氣切術後的氣囊釋放術是否可以預測氣切傷口感染的發生。從2005年4月到2006年5月，在呼吸加護病房中有些病人在氣切手術後曾接受氣切氣囊釋放術照護。我們收集所有接受氣切手術病人的臨床表徵與是否接受氣切氣囊釋放術的資料。定義氣切傷口感染爲傷口有紅、腫、膿樣的分泌物及有分泌物培養。然後分析這些病患的臨床表徵與氣切氣囊釋放術和氣切傷口感染的相關性。收集86位病人，其中有12位病人發生氣切傷口感染，比率爲13%。氣切傷口感染組的術前白血球偏高(15993 ± 1730 vs 11134 ± 415 cells/μl, p=0.004)。肺部浸潤持續或增加的情形在氣切傷口感染組也有增加的趨勢(91.7% vs 64.9%, p=0.094)。以有無接受氣切氣囊釋放術分成兩組，他們的氣切傷口感染率相似(5/43 vs 7/43, p=0.378)，但死亡率在沒有接受氣切氣囊釋放術的組別比較高(23.3% vs 7%, p=0.034)。沒有病人是因爲氣切手術的併發症直接導致死亡。當病人作氣切手術之前有白血球過高及肺部浸潤的情形時，外科醫師需要謹慎預防術後氣切傷口感染。氣切氣囊釋放術不會減少氣切傷口的發生率，但這些病人的死亡率較低。未施予氣切氣囊釋放術與病人死亡的因果關係需要進一步研究。
關鍵字
無資料並列摘要
Tracheostomy is a common procedure in mechanically ventilated patients. The incidence of tracheostomy stoma infection (TSI) varies among different institutes. The aim of this study was to investigate whether patients' characteristics, peri-operative data and tracheostomy cuff deflation were associated with TSI. Patients receiving tracheostomy operation in respiratory intensive care unit of our institution from April 2005 to May 2006 were studied retrospectively. Some of them received tracheostomy cuff deflation after operation. Patients' characteristics, peri-operative conditions and tracheostomy cuff deflation were reviewed from their medical records. TSI was defined as erythematous change, swelling around wound, purulent discharge from wound and discharge culture with bacterial growth. The difference among those factors in TSI and non-TSI patients and those with and without tracheosotmy cuff deflation was examined. Eighty-six patients who received tracheostomy were included. TSI occurred in 12 patients (13%). Leukocytosis before tracheostomy was associated with TSI (15993±1730 vs 11134±415 cells/μl, P=0.004). Persistent or increased pulmonary infiltrates were more common in TSI than in non-TSI patients (91.7% vs 64.9% P=0.094). The rates of TSI were similar between patients with and without tracheostomy cuff deflation (5/43 vs 7/43, P=0.378) but mortality rate was higher in patients without tracheosotmy cuff deflation (23.3% vs 7%, P=0.034). None of mortality cases died of tracheostomy. Surgeons should be aware of the possibility of TSI if the patient has leukocytosis and residual pulmonary infiltrates were found on CXRs before operation. In this study, tracheostomy cuff deflation did not reduce TSI. The casual relationship between tracheosotmy cuff deflation and mortality needs further study.
延伸閱讀
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