| Objective: To explore the influencing factors of the time and the results of extubation in patients with acute ischemic stroke(AIS)who require mechanical ventilation in the Neurological Intensive Care Unit(NICU)to guide the Department of Neurology Physicians make decisions on clinical extubation,use more clear clinical indicators to guide extubation practice,correctly grasp the timing and conditions of extubation,and provide references to avoid complications and adverse prognosis caused by a series of prolonged intubation and mechanical ventilation time.Methods: Retrospective analysis of patients with acute ischemic stroke requiring tracheal intubation treated in the Second Affiliated Hospital of Nanchang University from August 2017 to August 2019,and selected the clinical data of patients who met the success and failure of extubation,including age,Gender,anatomical location of cerebral infarction,infarct size,time of intubation and intubation,Glasgow Coma Scale(GCS),the National Institutes of Health Stroke Scale(NIHSS),acute physiology and chronic health score APACHE Ⅱ(acute physiology and chronic health evaluation scoring system),hemoglobin level,albumin level,blood sodium level,dysarthria,cough reflex,lung infection,hypertension Medical history,diabetes history,smoking history,and ventilator-related parameters including inhaled oxygen concentration(FIO2),tidal volume(VT),positive end-expiratory pressure(PEEP)and other clinically relevant indicators were analyzed by one-way ANOVA.Taking extubation failure as the dependent variable,independent factors with statistical significance as independent variables,continuous factors set the limit value,and then multi-factor binary logic analysis.Because the tube time is an ordered variable,the subjects included in the study were divided into 3 groups according to the patient’s tube time,1-3d,4-7d,8-14 d,respectively,and the clinical data were grouped and assigned to use ordered logistics regression analysis.Results: This group of 122 patients with AIS(72 males and 50 females)who were successful or failed in extubation met the inclusion criteria,aged 45 to 87 years,with an average age of approximately 68.8 years.There were 28 patients(23%)in the extubation success group and 94 patients(77%)in the extubation failure group.Extubation success and extubation failure were statistically significant between the two groups in age,endotracheal intubation time,NIHSS score,GCS score,APACHE II score,blood sodium level,superficial breathing index,infarct size,cough reflex,and dysarthria Difference(P <0.05),but gender,anatomical location of cerebral infarction,hemoglobin level,albumin level,VT,PEEP,hypertension,diabetes,lung infection and smoking history were not statistically different between the two groups(P> 0.05),after setting limit values for factors with statistical differences,a further binary logistic analysis showed that the admission GCS score was less than 8 points(OR = 2.6,P = 0.03)and the NIHSS score was ≥15 points(OR = 2.2,P = 0.001)Has a significant correlation(OR = 2.76,P = 0.03).In the extubation failure group,there were 56 cases(59.6%)in the 1-3d group,11 cases(11.7%)in the 4-7d group,and 27 cases(28.7%)in the 8-14 d group.After grouping and assigning clinical data to the patients,Perform an orderly logistics regression analysis.The results suggest that the influencing factors of extubation failure group include large-area infarction(P = 0.009),GCS score <8 points(P = 0.002),anemia(P <0.001),and dysarthria(P = 0.006).Conclusions: Based on traditional endotracheal intubation indications,NIHSS score≥15 and GCS score <8 are independent risk factors for extubation failure;large-area infarction,GCS score <8,low hemoglobin level,dysphonia are all Tube failure time of patients with tube failure is correlated,and the larger the infarct size,the lower the GCS score,the lower the hemoglobin level,the existence of dysphonia,the possibility of prolonging the tube time is greater,and the risk of extubation failure is increased. |
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