早期气管插管抢救重型颅脑损伤的疗效研究  

Curative effect of early tracheal intubation for severe craniocerebral injury

作　　者：杨祖清[1] 付守芝[1] 车军[1] 刘克地[1] 遇呈祥[1] 薛颖[2] 

机构地区：[1]郧阳医学院附属人民医院急诊科,湖北十堰442000 [2]华中科技大学同济医学院内科学系,湖北武汉430030

出　　处：《中国急救医学》2010年第2期164-167,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨早期气管插管对重型颅脑损伤的救治效果。方法将134例行气管插管的重型颅脑损伤患者（GCS≤8分）采用随机对照的研究方法分为两组，即早期气管插管组58例和常规气管插管组76例，两组在气管插管前后呼吸生理指标变化、上机概率、呼吸机治疗和ICU监护时间、并发症发生率及重残死亡率等方面进行比较。结果两组呼吸和生理监测指标在气管插管前后均有不同程度的提高，两组气管插管前后PaO2、PaCO2、SaO2、HR和RR比较差异均有统计学意义。两组在上机概率、机械辅助呼吸治疗时间、ICU监护时间以及并发ALI或ARDS、难治性肺炎、消化道出血、MODS和重残死亡等方面比较均具有统计学意义。结论重型颅脑损伤早期气管插管能更好地改善机体的缺氧，降低并发症发生率和重残死亡率，改善预后。Objective To investigate the curative effect of early tracheal intubation in the patients with severe craniocerebral injury. Methods 134 cases with severe craniocerebral injury （Glasgow Coma Scale, GCS≤8 ） receiving tracheal intubation were divided into two groups according to randomized controlled method, routine tracheal intubation group （76 cases） and early tracheal intubation group （58 cases）. To compare the respiratory and physiological monitoring indexes, the probability of receiving breathing machine, the time of ventilator treatment and intensive care unit （ICU） monitoring, the incidence of complications, and the mortality of the severe disability before and ＇after tracheal intubation. Results The respiratory and physiological monitoring indexes （ PaO2 , PaCO2 , SaO2 , HR, RR） were improved to some extent after tracheal intubation. There were statistical differences in the above mentioned indexes before and after tracheal intubation of the two groups. There were also significant differences in the probability of receiving breathing machine, the time of ventilator treatment and ICU monitoring, the incidence of complications （ALI or ARDS, refractor5, pneumonia, gastrointestinal hemorrhage and MODS）, the mortality of the severe disability and the prognosis between two groups. Conclusion Early tracheal intubation for severe craniocerebral injury can improve organism hypoxia, reduce the incidence of complications and the mortality of the severe disability, and improve prognosis.

关 键 词：重型颅脑损伤 气管插管 早期 

分 类 号：R722.12[医药卫生—儿科] R651.15[医药卫生—临床医学]