重型脑外伤早期实施机械通气的临床研究  

Clinical Study of Early Application of Mechanical Ventilation in Patients with Severe Traumatic Brain Injury

作　　者：孙鸿礼[1] 夏连贵[2] 方晨光[1] 倪军喜[1] 田继文[1] 贺崇新[2] 

机构地区：[1]皖南医学院附属池州医院(池州市人民医院)ICU,安徽省池州市247000 [2]皖南医学院附属池州医院(池州市人民医院)神经外科,安徽省池州市247000

出　　处：《中华全科医学》2010年第2期177-178,180,共3页Chinese Journal of General Practice

摘　　要：目的探讨重型脑外伤患者早期实施机械通气的价值。方法将81例重型脑外伤患者随机分为对照组和观察组。两组均按常规进行内科治疗及相应的手术治疗;对照组38例先予鼻导管持续吸氧,出现呼衰时使用机械通气;观察组43例伤后或术后即刻实施机械通气;比较两组通气前后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧饱和度(SaO2)等血气指标变化及伤后半年格拉斯哥预后评分(GOS)。结果两组患者机械通气后PaO2、PaCO2、SaO2等血气指标变化均有显著改善,但观察组通气效果更好,通气时间更短;GOS显示,观察组生存质量优于对照组(P<0.05)。结论对重型脑外伤患者早期实施机械通气能更有效改善重型脑外伤患者的缺氧状态,缩短机械通气时间,能改善生存者的生存质量。Objective To investigate the value of the early mechanical ventilation in patients with severe traumatic brain injury（TBI）.Methods 81 cases with severe TBI（GCS scored 3 to 8） in our department were randomly divided into two groups：the control group（n=38） and the observation group（n=43）.All patients received routine medical and surgical treatments.In the control group,patients were treated with continuous nasal tube or veil oxygen inhalation followed by mechanical ventilation when respiratory failure occurred.In the observation group,patients were treated with mechanical ventilation immediately after brain injury or operation.Blood gas indices such as PaO2,PaCO2 and SaO2 before and after the application of mechanical ventilation were comparatively analyzed between the two group.According to GOS scores,the living situation of both groups was evaluated at the 6th month after treatment.Results Blood gas indices such as PaO2,PaCO2 and SaO2 were significantly improved after the application of mechanical ventilation in two groups（P0.05）.Compared with the control group,the observation group exhibited shorter duration of mechanical ventilation（P0.05）,better ventilation efficacy and living quality at the 6th month after treatment（P0.05）.Conclusion Early ventilation can more effectively improve hypoxia and induce the duration of mechanical ventilation and improve life quality in patients with severe TBI compared to conventional ventilation.

关 键 词：早期机械通气 重型 颅脑损伤 生存质量 

分 类 号：R651.15[医药卫生—外科学] R56[医药卫生—临床医学]