早期气管切开对EICU危重症患者使用镇痛镇静药的预后影响
Prognostic Effect of Early Tracheostomy on the Use of Analgesic Sedatives in Critically Ill Patients with EICU

气管切开术是重症监护病房最常见的干预措施之一。多达10%需要至少3天机械通气的患者最终将接受气管切开术以延长机械通气或气道支持时间。虽然长时间的呼吸衰竭可能是气管切开术最常见的原因，但其他症状如意识水平下降、气道保护性反应差、创伤和医疗疾病相关的严重生理改变也都是气管切开术的指征。随着微创气管切开术技术的发展，可以在病人床边安全实施，实施气管切开术的频率似乎在增加。研究表明，相对于持续的经喉气管插管，使用气管切开术可以减少镇静镇痛需求、降低呼吸相关性肺炎发生率和死亡率、提高患者舒适度。同样有证据表明，早期经皮扩张气管切开术对EICU (Emergency Intensive Care Unit, EICU)危重症患者的治疗成本和减少相关疾病并发症方面是大有益处的，在很多时候应该被认为是EICU危重症患者的首选通气支持方法。
Tracheostomy is one of the most common interventions in intensive care units. Up to 10% of pa-tients requiring at least 3 days of mechanical ventilation will eventually undergo tracheostomy to prolong mechanical ventilation or airway support. Although prolonged respiratory failure may be the most common cause of tracheostomy, other symptoms such as decreased level of consciousness, poor airway protection, trauma, and severe physiologic changes associated with medical conditions are also indications for tracheostomy. With the development of minimally invasive tracheostomy techniques, which can be safely performed at the patient’s bedside, the frequency of tracheostomy appears to be increasing. Studies have shown that the use of tracheostomy reduces the need for se-dation and analgesia, reduces the incidence and mortality of respiratory-related pneumonia and mortality, and improves patient comfort compared with ongoing translaryngotracheal intubation. There is also evidence that percutaneous dilated tracheostomy has significant benefits in terms of treatment costs and reducing associated complications in critically ill patients with EICU (Emer-gency Intensive Care Unit, EICU), and should in many cases be considered the preferred ventilatory support method for critically ill patients with EICU.