Study on the Correlation Mechanism and Application of Genetic Susceptibility, Hemoglobin Adaptation Changes, and Extubation Success Rate in Stroke Patients With Tracheotomy at Different Altitudes

Inclusion criteria

• Age between 18 and 75 years.
• Hospitalized patients in the rehabilitation department with acute non-traumatic ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage requiring tracheostomy.
• Hemodynamic stability: Systolic blood pressure maintained between 90-160 mmHg, diastolic blood pressure between 60-100 mmHg, respiratory rate between 12-30 breaths/min, heart rate between 60-120 beats/min, body temperature between 36.5°C-38.5°C, and arterial oxygen saturation (SaO₂) consistently >90% at admission and prior to tracheostomy.
• Glasgow Coma Scale (GCS) score of 5-15 at assessment.
• Tracheostomy performed within 24-72 hours after stroke onset.
• Peripheral blood hemoglobin concentration at admission within specified ranges (male: 120-180 g/L; female: 110-160 g/L).
• Signed informed consent provided by the patient or legal guardian.

Exclusion criteria

• History of severe cardiopulmonary dysfunction (e.g., chronic obstructive pulmonary disease, cor pulmonale, coronary artery disease, cardiomyopathy) with New York Heart Association (NYHA) functional class III or IV, or recent (within 6 months) acute myocardial infarction or unstable angina.
• Diagnosis of advanced malignancy (life expectancy <6 months) with ongoing chemotherapy, radiotherapy, or palliative care.
• Severe hepatic or renal insufficiency (e.g., decompensated cirrhosis, chronic renal failure requiring long-term dialysis).
• Uncontrolled endocrine disorders (e.g., thyrotoxic crisis, myxedema coma, diabetic ketoacidosis, hyperosmolar hyperglycemic state).
• Coagulation disorders:

• Congenital or acquired coagulopathies (e.g., hemophilia, vitamin K deficiency, coagulation factor deficiency due to severe liver disease, antiphospholipid syndrome).
• Active anticoagulation therapy (e.g., warfarin with INR >3.0, heparin with APTT exceeding twice the upper limit of normal) unadjustable to a safe range within 72 hours.
• Major surgery within 3 months (e.g., cardiac, abdominal, or orthopedic surgery).
• Severe chest trauma (e.g., multiple rib fractures, pneumohemothorax) or abdominal trauma (e.g., liver/spleen rupture, intestinal perforation) within 1 month prior to stroke onset, with incomplete recovery.
• Active uncontrolled infection at admission (e.g., pneumonia, urinary tract infection, intracranial infection, sepsis) defined by:

• Temperature >38.5°C persisting >24 hours.
• Elevated white blood cell count, increased neutrophil percentage, and clinical signs of infection.
• Positive bacterial cultures (blood, sputum, urine).
• Recent (within 1 week) exposure to infectious diseases (e.g., travel to epidemic areas, contact with confirmed cases) with suspected latent or active infection.
• History of neurodegenerative diseases (e.g., Parkinson's disease, Alzheimer's disease) or motor neuron disorders (e.g., amyotrophic lateral sclerosis).
• Congenital neurological developmental abnormalities (e.g., hydrocephalus, cerebral palsy).
• Severe uncontrolled psychiatric disorders (e.g., schizophrenia, major depressive disorder, bipolar disorder) impairing daily function or treatment adherence.
• Cognitive impairment (e.g., dementia) with Mini-Mental State Examination (MMSE) score <10.
• Pregnancy or lactation.
• Hypersensitivity or contraindications to study-related drugs or procedures (e.g., allergy to tracheostomy tube materials, antibiotic allergies without alternatives).
• Inability to complete follow-up or required tests (e.g., geographical barriers, unreliable contact information).
• Non-compliance of the patient or family members with the study protocol.
• Failure to obtain informed consent.
• Participation in other interventional clinical trials.