目的评价气管切开时机对需长期机械通气患者的影响。方法 167例日照市中医医院急诊科重症监护室(ICU)收治的进行经皮扩张气管切开术(PDT)的急危重症患者作为研究对象,依据经口气管插管机械通气时间将患者分成两组,其中≤7 d行PDT的患者81例为早期气切组,>7 d行PDT的患者86例为晚期气切组,对两组经口气管插管机械通气时间、PDT时间、PDT后机械通气时间、总机械通气时间、在PDT后住ICU时间、ICU住院时间、总住院时间以及病死率进行比较,并进行相关分析。结果早期气切组经口气管插管机械通气时间为(5.16±1.33)d、PDT时间为(5.16±1.33)d、PDT后机械通气时间为(15.16±1.05)d、总机械通气时间为(18.02±2.03)d、在PDT后住ICU时间为(16.05±1.25)d、ICU住院时间为(21.13±0.25)d优于晚期气切组的(11.64±4.25)、(11.64±4.25)、(17.18±1.23)、(26.02±3.03)、(21.08±1.55)、(32.25±1.35)d,差异均有统计学意义(P<0.05)。两组患者总住院时间、ICU住院病死率以及住院病死率比较,差异均无统计学意义(P>0.05)。单因素回归分析显示,总机械通气时间与PDT时间呈正相关(r=0.552,t=8.495,P=0.000<0.05)。损伤严重度评分、PDT后机械通气时间、总机械通气时间与延长ICU住院时间均具有相关性(P<0.05);年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和格拉斯哥昏迷评分(GCS)与延长ICU住院时间无明显相关性(P>0.05)。多因素方差分析显示,总机械通气时间是ICU住院时间延长的独立危险因素[OR=4.700,95%置信区间=(0.990,2.614),F=106.200,P=0.000<0.05]。结论急危重症患者行早期气切可缩短机械通气时间和ICU住院时间,但不影响患者的预后,对需长期机械通气患者气管切开时机宜采用7 d内进行。 Objective To evaluate the effect of tracheotomy on long-term mechanical ventilation. Methods A total of 167 acute critically ill patients with percutaneous dilation and tracheostomy (PDT) underwent intensive care unit (ICU) in emergency department of Rizhao City Chinese Medicine Hospital were divided into two groups according to the duration of orotracheal intubation mechanical ventilation Group, 81 patients with PDT less than 7 days were treated by early gas-cutting group and 86 patients with> 7 days PDT were treated by late gas-cutting group. The mechanical ventilation time, PDT time and PDT Mechanical ventilation time, total mechanical ventilation time, post-PDT ICU stay, ICU stay, total hospital stay and mortality were compared and analyzed. Results The duration of mechanical ventilation was (5.16 ± 1.33) days, (5.16 ± 1.33) days for PDT and (15.16 ± 1.05) days for PDT, and the total duration of mechanical ventilation was ( 18.02 ± 2.03) d. The ICU stay time after PDT was (16.05 ± 1.25) days and ICU hospital stay time was (21.13 ± 0.25) days, which was significantly higher than that of late stage airototomy group (11.64 ± 4.25, 11.64 ± 4.25, 17.18 ± 1.23), (26.02 ± 3.03), (21.08 ± 1.55) and (32.25 ± 1.35) d respectively. There were significant differences between the two groups (P <0.05). There was no significant difference in the total length of stay, ICU in-hospital mortality and in-hospital mortality between the two groups (P> 0.05). Univariate regression analysis showed that total mechanical ventilation time was positively correlated with PDT time (r = 0.552, t = 8.495, P = 0.000 <0.05). The scores of injury severity, mechanical ventilation time after PDT, total mechanical ventilation time and length of hospital stay were correlated (P <0.05); age, APACHEⅡ score and Glasgow Coma Scale GCS) had no significant correlation with prolonging ICU length of stay (P> 0.05). Multivariate analysis of variance showed that total mechanical ventilation was an independent risk factor for prolonged ICU stay [OR = 4.700, 95% CI = (0.990, 2.614), F = 106.200, P = 0.000 <0.05]. Conclusions Early acute gasototomy can shorten the duration of mechanical ventilation and ICU stay, but does not affect the prognosis of patients. The timing of tracheotomy in patients with long-term mechanical ventilation should be taken within 7 days.