The Impact Of Tracheotomy Timing On Clinical Prognosis In Acute Ischemic Stroke

Objective: This study aims to investigate the impact of tracheotomy timing on the clinical prognosis of acute ischemic stroke patients.Methods: This is a retrospective-prospective study of 122 patients who were admitted to the department of the Neurointensive Care Unit(NICU),Intensive Care Unit(ICU)and Emergency Intensive Care Unit of the second affiliated Hospital of Dalian Medical University from September 2016 to January 2019.According to the time of tracheotomy,they are divided into two groups: early tracheotomy group(7 days after tracheotomy)and late tracheotomy group(7 days after tracheotomy).Collect basic information of patients [ age,sex,hypertension,diabetes,smoking,drinking,atrial fibrillation,admission NIHSS score(National Institute of Health stroke scale),GCS score(Glasgow Coma Scale),hypercholesterolemia,liver function,renal function,myocardial markers,Carotid Atherosclerosis and Acute Physiology And Chronic Health Evaluation(APACHEII scores)]and clinical indicators(hospitalization time,time of intensive care,time of mechanical ventilation,duration of SIRS,duration of antibiotic use,number of complications,discharged NIHSS score,Essen score,hospital mortality),which are analyzed and compared between the two groups.According to the prognosis of the patients,they are divided into improvement group and death group.Theinfluenceofage,sex,hypertension,diabetes,smoking,drinking,atrialfibrillation,hyperch olesterolemia,admission NIHSS score,GCS score,APACHEII score,liver function,renal function,heart function,myocardial markers,carotid atherosclerosis and time of tracheotomy on the clinical prognosis of patients with acute ischemic stroke.Furtherapplication of multi-factor analysis to identify the independent risk factors affecting the clinical outcome of patients with acute ischemic stroke.Results: 1.Demographic characteristics: This study includ 122 patients with acute ischemic stroke who met the criteria of the study.The mean age is 68.11 ±12.33 years,male 83 cases(68.03%),median admission NIHSS score 17.00,GCS median 9 points.The median APACHEII score is 33.97(79.51%)patients with hypertension,50(40.98%)patients with diabetes,42(34.43%)patients with atrial fibrillation,51(41.80%)smokers,28(22.95%)drinkers.There are 51 cases(41.80%)with hypercholesterolemia,47 cases(38.52%)with abnormal liver function,25 cases(20.49%)with abnormal renal function,55 cases(45.08%)with abnormal myocardial markers.There are 76 cases(62.30%)with carotid atherosclerosis and 41 cases(33.61%)died.According to the time of tracheotomy,76 cases(62.30%)are divided into early tracheotomy group.The average age is 69.81 ±11.71 years old.50 cases(65.79%)are male.The median NIHSS score and GCS score are 17.00 and 8.00 respectively.The median APACHEII score is 32.50 and the number of deaths is 20(26.31%).There are46 cases(37.70%)in the late tracheotomy group,with an average age of 68.02 ±11.37 years,33 males(71.74%).The median NIHSS score,GCS score and APACHEII score are 17.00,10.50 and 34.00 respectively.The death toll is 21(45.65%).2.Differences in basic data: There is no significant difference in age,sex,hypertension,diabetes,smoking,drinking,atrial fibrillation,admission NIHSS score,GCS score,hyperlipidemia,liver function,renal function,myocardial markers,carotid atherosclerosis between the early tracheotomy group and late tracheotomy group(P>0.05),but there is significant difference in APACHEII score between the two groups.3.The difference of clinical prognosis: In terms of clinical prognosis,the hospitalization time,time of intensive care,time of mechanical ventilation,duration of SIRS,time of antibiotic application,number of complications and hospital mortality in the early tracheotomy group are significantly shorter than those in the late tracheotomy group.The difference between the two groups is statistically significant(P < 0.05),butthere is no significant difference in the NIHSS score and Essen score between the two groups(P > 0.05).4.Risk factors: According to the clinical prognosis,patients are divided into improved group and death group.Age,sex,admission NIHSS score,GCS score,APACHEII score,hypertension,diabetes mellitus,smoking history,drinking history,atrial fibrillation hypercholesterolemia,liver function,renal function,myocardial markers,carotid atherosclerosis and timing of tracheotomy were analyzed and compared between the two groups.Further,Logistic regression analysis show that admission NIHSS score,GCS score and timing of tracheotomy are independent risk factors for clinical prognosis of patients with acute ischemic stroke.Conclusion: 1.Tracheotomy should be performed as early as possible in patients with acute ischemic cerebral apoplexy who can not remove ventilator for a long time.Early tracheotomy can significantly shorten the time of hospitalization,intensive care and mechanical ventilation.The duration of SIRS,the duration of antibiotic administration and the reduction of the number of complications;However,there was no significant improvement in NIHSS score,ESSEN score and hospital mortality.2.By comparing and analyzing the risk factors affecting the clinical prognosis of patients with acute ischemic stroke,it was concluded that admission NIHSS score,GCS score and timing of tracheotomy were independent risk factors for the clinical prognosis of patients with acute ischemic stroke.Early tracheotomy may reduce mortality in patients with acute ischemic stroke undergoing mechanical ventilation.