经皮气管切开术后早期感染参数的变化

G. Turan
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摘要

简介:虽然气管切开术(TO)是重症监护病房(ICU)中需要长时间住院和机械通气(MV)支持的患者的首选,但这一手术会带来严重的并发症,如出血、气管损伤、气胸、肺气肿和感染。在我们的回顾性研究中,我们评估了经皮TO术后的早期感染参数。我们还旨在评估在没有任何其他原因的情况下在to后的前48小时内所做的更改。方法:经我院科学研究委员会批准(决定号17017317 - 05006),回顾性分析2018年1月至2019年6月行TO手术的125例患者资料。在我们的诊所,经皮TO是在床边按照无菌条件进行的。如果接受手术的患者不使用抗生素,则不给予预防性抗生素。在我们的研究中,我们检查了患者的人口统计学资料,APACHE-II, SAPS-2,初次诊断,TO开放时间,气管切开术前后的c反应蛋白,白细胞,中性粒细胞淋巴细胞比,MV天时间,ICU出院和是否存在死亡。结果:平均年龄70±17.3岁,APACHE-II平均年龄17.1±6.3岁,病死率36.4%。注射后未发现抗生素变化。注射后感染参数的变化和抗生素使用情况下感染参数的百分比变化率均无差异。讨论与结论:由于TO开放期通常在重症监护住院第10天之后,患者可能因其他原因出现感染迹象。我们认为重症监护中经皮应用TO也可能是感染的主要来源,因此,有必要注意这一时期感染参数的随访。
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Changes In Early Infection Parameters After Percutaneous Tracheotomy
Introduction: Although tracheotomy (TO) is preferred in patients who require long hospital stays and mechanical ventilation (MV) support in the intensive care unit (ICU), it is a procedure that carries serious complications such as bleeding, tracheal damage, pneumothorax, emphysema, and infection. In our retrospective study, we evaluated early infection parameters after percutaneous TO. We also aimed to evaluate changes made in the first 48 h after TO without any other reason. Methods: We retrospectively evaluated the data of 125 patients who underwent TO between January 2018 and June 2019 by obtaining the permission of the scientific study committee of our hospital with the decision numbered 170173117–05006. In our clinic, percutaneous TO is performed at the bedside in accordance with sterile asepsis conditions. If the patient who underwent the procedure does not use antibiotics, prophylactic antibiotics are not administered. In our study, demographic data of the patients, APACHE-II, SAPS-2, primary diagnosis, TO opening time, C-reactive protein before and after tracheotomy, leukocytes, neutrophil–lymphocyte ratio, MV day time, ICU discharge, and presence of mortality were examined. Results: The mean age was 70±17.3, APACHE–II mean was 17.1±6.3, and mortality was 36.4%. No antibiotic changes were detected after TO. No differences were observed in the infection parameter changes after TO and the percentage change rates of infection parameters according to the presence of antibiotic use. Discussion and Conclusion: Since the TO opening period is usually after the 10th day of intensive care hospitalization, patients may show signs of infection due to other causes. We are of the opinion that percutaneous TO applications in intensive care may also be a primary source of infection, and therefore, it is necessary to pay attention to the follow-up of infection parameters in this period.
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