早期气管切开对需要有创机械通气治疗的结核性脑膜炎患者的影响

doi:10.19871/j.cnki.xfcrbzz.2026.03.006

摘要/Abstract

摘要： 目的探讨早期气管切开（early tracheostomy,ET）对需要有创机械通气（invasive mechanical ventilation,IMV）治疗的结核性脑膜脑炎患者的影响,为临床呼吸支持策略优化提供依据。方法采取病例对照的研究方法,选取2022年1月至2024年12月成都市公共卫生临床医疗中心重症监护室需要IMV治疗的结核性脑膜炎患者为研究对象,将接受ET的患者作为ET组（29例）,同期接受晚期气管切开的患者作为对照组（58例）。收集两组患者的流行病学资料、合并症、神经系统并发症、入住重症监护室后48h内最高急性生理与慢性健康评分、入住重症监护室后首次格拉斯哥昏迷评分、IMV治疗原因、IMV治疗前实验室检查、镇痛时间、IMV治疗时间、IMV治疗并发症、重症监护室住院时间、住院28d临床结局（存活、死亡）等,并对比上述临床指标。结果所有患者中,气道清除能力差所致反复误吸是结核性脑膜脑炎患者最主要的行IMV治疗的原因。ET组患者在镇静时间[（8.8±1.9）d比（12.7±2.6）d,P< 0.001]、IMV治疗时间（10.2d比16.4d,P<0.001）以及重症监护室住院时间（12.3d比17.5d,P<0.001）均显著短于对照组患者。两组患者在VAP发生率、气胸、皮下气肿、纵隔气肿、气道出血、气道狭窄、气管食管瘘以及28d住院临床结局比较,差异均无统计学意义（P>0.05）。结论对于需要IMV治疗的结核性脑膜脑炎患者,接受ET,可减少此类患者镇静时间、IMV治疗及重症监护室的住院时间,但不能改善住院28d的预后。

关键词: 早期气管切开, 有创机械通气, 结核性脑膜炎, 重症监护, 预后

Abstract: Objective To explore the effect of early tracheostomy(ET) on patients with tuberculous meningitis requiring invasive mechanical ventilation(IMV). Method A case-control study was conducted. Patients with tuberculous meningitis who received IMV treatment in the Intensive Care Unit of Chengdu Public Health Clinical Medical Center from January 2022 to December 2024 were enrolled. Patients undergoing ET were assigned to the ET group(n=29), and those receiving late tracheostomy during the same period were set as the control group(n=58). Epidemiological characteristics, comorbidities, neurological complications, the highest Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score within 48 hours after ICU admission, the initial Glasgow coma scale(GCS) score upon ICU admission, indications for IMV initiation, laboratory parameters before IMV, analgesia duration, duration of IMV, IMV-related complications, length of ICU stay, and 28-day in-hospital clinical outcomes (survival and death) were collected and compared between the two groups. Result Repeated aspiration caused by poor airway clearance was the leading indication for IMV support in patients with tuberculous meningitis. Compared with the control group, the ET group presented significantly shorter sedation duration, IMV duration and ICU stay length [(8.8±1.9）d vs (12.7±2.6)d, P<0.001; median:10.2d vs 16.4d, P<0.001; median:12.3d vs 17.5d, P<0.001]. There were no significant differences between the two groups in the incidence of ventilator-associated pneumonia, pneumothorax, subcutaneous emphysema, mediastinal emphysema, airway hemorrhage, airway stenosis, tracheoesophageal fistula, and 28-day in-hospital prognosis (P>0.05). Conclusion For patients with tuberculous meningitis requiring IMV, early tracheostomy can shorten sedation duration, IMV duration and ICU stay length, while it cannot improve the 28-day in-hospital prognosis.

Key words: Early tracheotomy, Invasive mechanical ventilation, Tuberculous meningitis, Intensive care, Prognosis

中图分类号:

R529.3

程耀, 吴桂辉, 毛毅, 罗海霞, 李玉科. 早期气管切开对需要有创机械通气治疗的结核性脑膜炎患者的影响[J]. 新发传染病电子杂志, 2026, 11(3): 30-35.

Cheng Yao, Wu Guihu, Mao Yi, Luo Haixia, Li Yuke. Effect of early tracheotomy on patients with tuberculous meningitis who need invasive mechanical ventilation[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 30-35.

参考文献

[1] MISRA UK,KALITA J,KUMAR M,et al.Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort[J]. Int J Tuberc Lung Dis,2020,24(11): 1194-1199.
[2] KALITA J,MISRA UK,SINGH VK,et al.Inclusion of mechanical ventilation in severity staging of tuberculous meningitis improves outcome prediction[J]. Am J Trop Med Hyg,2020,103(2): 689.
[3] LI Y,WAN D,LIU H,et al.Association of early versus late tracheostomy with prognosis in hypoxic‐ischaemic encephalopathy patients: A propensity‐matched cohort study[J]. Nurs Crit Care,2025,30(2): e13268.
[4] MAO X,ZHOU Y,CHEN Q,et al.Clinical management and nursing care for patients with tracheostomy following traumatic brain injury[J]. Front Neurol,2024,15: 1455926.
[5] BERTINI P,MARABOTTI A,PATERNOSTER G,et al.Early versus late tracheostomy for traumatic brain injury: a systematic review and meta-analysis. Minerva Anestesiol. 2023;89(5):455-467.
[6] ABDELLA A,DEGINET E,WELDEGEBREAL F,et al.Tuberculous Meningitis in children: treatment outcomes at Discharge and its Associated factors in Eastern Ethiopia: a five years retrospective study[J]. Infect Drug Resist,2022: 2743-2751.
[7] 中华医学会结核病学分会结核性脑膜炎专业委员会. 2019中国中枢神经系统结核病诊疗指南[J]. 中华传染病杂志,2020,38(7):400-408.
[8] 中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学,2007,19(2):65-72.
[9] GROTOWSKA M,SKALEC T,WÓJTOWICZ I,et al. Early tracheostomy in ventilated COVID-19 patients reduces incidence of ventilator-associated pneumonia[J]. Sci Rep-uk,2024,14(1): 29472.
[10] MARRA A,VARGAS M,BUONANNO P,et al.Early vs. late tracheostomy in patients with traumatic brain injury: systematic review and meta-analysis[J]. J Clin Med,2021,10(15): 3319.
[11] DOU H,HU F,WANG W,et al.Assessment of the sedative effects of dexmedetomidine and propofol treatment in patients undergoing mechanical ventilation in the ICU and relationship between treatment and occurrence of ventilator-associated pneumonia and detection of pathogenic bacteria[J]. Exp Ther Med,2020,20(1): 599-606.
[12] GOO ZQ,MUTHUSAMY KA.Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: A randomized controlled trial[J]. J Clin Neurosci,2022,98: 162-167.
[13] HABIBZADEH A,KHADEMOLHOSSEINI S,TAHERI R,et al.The Field Attributes May not Accurately Predict the Need for Early Tracheostomy Tube Insertion in Severe TBI Patients: A New Insight With the Help of AI Algorithms[J]. Health Sci Rep-Us,2025,8(3): e70556.
[14] NGXABI B,HARDCASTLE TC.Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province,South Africa,compared with international benchmarks[J].S Afr J Crit Care,2024,40(3): e1967.
[15] QUINN L,VEENITH T,BION J,et al.Bayesian analysis of a systematic review of early versus late tracheostomy in ICU patients[J]. Brit J Anaesth,2022,129(5): 693-702.
[16] ROUYER M,STRAZZULLA A,YOUBONG T,et al.Ventilator-associated pneumonia in COVID-19 patients: a retrospective cohort study[J]. J Antibiot,2021,10(8): 988.
[17] KHAN M,PRABHAKARAN K,JEHAN F,et al.Early tracheostomy in patients with cervical spine injury reduces morbidity and improves resource utilization[J]. Am J Surg,2020,220(3): 773-777.
[18] TOMASZEK L,PAWLIK J,MAZUREK H,et al.Automatic continuous control of cuff pressure and subglottic secretion suction used together to prevent pneumonia in ventilated patients—a retrospective and prospective cohort study[J]. J Clin Med,2021,10(21): 4952.
[19] MAO Z,GAO L,WANG G,et al.Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis[J]. Crit Care,2016,20: 1-14.
[20] QUIÑONES-OSSA GA,DURANGO-ESPINOSA YA PADILLA-ZAMBRANO H,et al. Current status of indications,timing,management,complications,and outcomes of tracheostomy in traumatic brain injury patients[J].J Neurosci Rural Pract,2020,11(2): 222.
[21] DUGGAN J,PETERS A,HALBERT S,et al.Microbiology of Infective Endocarditis in United States Veterans—Association Between Causative Organism and Short-and Long-Term Outcomes[J]. Heart Surg Forum. 2023,26(6): E791-E799.
[22] GE W,WEI W,SHUANG P,et al.Nasointestinal tube in mechanical ventilation patients is more advantageous[J].Open Med-warsaw,2019,14(1): 426-430.
[23] DE FRANCA SA,TAVARES W M,SALINET A S M,et al. Early tracheostomy in severe traumatic brain injury patients: a meta-analysis and comparison with late tracheostomy[J]. Crit Care Med,2020,48(4): e325-e331.
[24] TAVARES W M,DE FRANÇA S A,PAIVA W S,et al. Early tracheostomy versus late tracheostomy in severe traumatic brain injury or stroke: A systematic review and meta-analysis[J]. Aust Crit Care,2023,36(6): 1110-1116.
[25] BÖSEL J, NIESEN WD, SALIH F, et al. Effect of early vs standard approach to tracheostomy on functional outcome at 6 months among patients with severe stroke receiving mechanical ventilation: the SETPOINT2 randomized clinical trial[J]. Jama, 2022, 327(19): 1899-1909.
[26] PREMRAJ L, CAMARDA C, WHITE N, et al.Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression[J]. Crit Care, 2023, 27(1): 132.
[27] GIANNAKOULIS VG, PSYCHOGIOS G, ROUTSI C, et al.Effect of early versus delayed tracheostomy strategy on functional outcome of patients with severe traumatic brain injury: A target trial emulation[J]. Crit Care Explor, 2024, 6(8): e1145.
[28] 霍勇军,战云飞,刘国利,等.结核性脑膜炎相关诊断指标分析[J/CD].新发传染病电子杂志,2017,2(2):85-88.