摘要:Objective To study the relevant factors of extubation success rate to neurological critically patients with tracheotomy. Meth-ods A retrospective analysis in January 2004 to October 2013 in our hospital neurology intensive care unit(NICU)was performed in 223 cases of critically neurological patients with tracheotomy. All these patients were divided into two groups according to the success of extubation. Two groups were compared with the basic clinical data when tracheostomy tube removal. The clinical data included vital organ function,glasgow Coma Scale (GCS)score,respiratory parameters,lung infection control situation,nutritional status,cough reflex,and the presence or absence of intubation time between tests plugging differences. Results Successful extubation was observed in 198 of 223 cases with tracheotomy,while 25 cases show-ing extubation failure. Univariate analysis showed that six risk factors,including age,major organ dysfunction,severe anemia,hypoproteinemia, rapid breathing,poor cough reflex associated with extubation failure( P ﹤ 0. 01). Logistic regression analysis showed significant organ dysfunc-tion,severe anemia,hypoalbuminemia,poor cough reflex were more closely associated with extubation failure. Among all these factors,poor cough reflex is the greatest relative risk factor. Conclusion Vital organ dysfunction,severe anemia,hypoalbuminemia,poor cough reflex in critically patients can predict extubation success in tracheotomy patients. The patient′s age,the nature of the primary disease,the degree of consciousness breathing parameters,intubation time in predicting extubation success rate did not show difference. In addition to emphasis on extubation lung in-fection control,the patient′s general condition,nutritional status,respiratory functional reserve,especially with heavy cough should be paid atten-tion.%目的:探讨影响神经危重症气管切开患者拔除气管插管成功率的相关因素。方法回顾性分析2004年1月至2013年10月神经科重症监护病房(NICU)收治的223例神经危重症并气管切开患者。按拔管是否成功分为两组。比较两组患者拔除气管切开插管时的基本临床资料、重要脏器功能、格拉斯哥昏迷量表(GCS)评分、呼吸参数、肺部感染控制情况、营养状况、咳嗽反射、插管时间以及有无进行堵管试验之间的差异。结果223例气管切开患者拔管成功198例,拔管失败25例。单因素分析显示,高龄、重要脏器功能不全、中重度贫血、低蛋白血症、呼吸过快、咳嗽反射差共6个危险因素与拔管失败有显著相关( P 均﹤0.01)。多因素 Logistic 回归分析显示,重要脏器功能不全、中重度贫血、低蛋白血症、咳嗽反射差与拔管失败较为密切,其中咳嗽反射差相对危险度最大,是预测拔管失败最重要的危险因素。结论重要脏器功能不全、中重度贫血、低蛋白血症、咳嗽反射差对于预测神经危重症患者气管切开拔管能否成功存在意义,而患者的年龄、原发病性质、意识障碍程度呼吸参数、插管时间对于预测拔管能否成功暂无明确意义。拔管时除重视肺部感染控制外,还要重视患者的全身情况、营养状况、呼吸功能储备,特别是咳嗽是否有力。