Objective To discuss suitable artificial airway for patients with traumatic high paraplegia and nursing strategy. Methods A retrospective study was conducted among 112 patients with traumatic high paraplegia to collect cases of tracheal intubation and tracheotomy 1 d and 7 d after injury. Results The incidence of tracheotomy of patients who were with C4、C5、C6 segment injuries were 100% (12/12). 93% (26/28)and 18%(2/11)respectively, 7 d after injury. The incidence of ventilator-associated pneumonia (VAP) of patients who received tracheotomy for the first time and those with tracheal intubation were 24%(10/41) and 54% (38/71), the result of which was statistically significant (P<0.05). Conclusion There are more risks in tracheal intubation than in tracheotomy for patients with high paraplegia. Tracheotomy is recommended for patients with injuries in and above C5 spinal level.%目的 探讨不同平面创伤性高位截瘫患者人工气道的类型选择及护理策略.方法 回顾性分析2009年10月-2010年10月112例急性颈椎及胸椎创伤致高位截瘫的患者,统计本组患者不同损伤节段伤后1 d气管插管及气管切开的例数及1周后气管插管及气管切开的例数,并探讨护理对策.结果 C4、C5、C6平面损伤患者1周后改为气管切开率分别为100%(12/12)、93%(26/28)、18%(2/11);初次气管切开及气管插管者发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)分别为24%(10/41)、54%(38/71),两者比较差异有统计学意义(P＜0.05).结论 高位截瘫患者气管插管比气管切开VAP发生率风险较高,对于损伤在C5脊神经及以上水平的患者,宜尽早配合医生行气管切开.
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