重症颅脑损伤术后早期气管切开对防止肺部感染的影响  

The impact of earlier period tracheotomy on preventing pulmonary infection after heavy craniocerebral injury

作　　者：张志宏[1] 许海雄[1] 李克民[1] 柳隆华[1] 

机构地区：[1]汕头市中心医院神经外科,515031

出　　处：《中国实用医药》2010年第12期52-54,共3页China Practical Medicine

摘　　要：目的研究重症颅脑损伤术后早期气管切开对防止肺部感染的影响。方法回顾性选择重症颅脑损伤患者,急诊开颅手术后≤24 h气管切开患者40例,另急诊开颅手术后未于早期气管切开(即切开时间>24 h或未行气管切开的患者)40例,所有患者术后均用头孢三代,半合成青霉素静脉滴注预防感染,出现肺部感染者均行痰培养药敏试验,选择敏感药物进行治疗。结果52例患者出现肺部感染,其中实验组16例有12例感染控制,感染控制时间4～10 d,平均6.5 d。对照组36例,有12例感染控制,感染控制时间为10～20 d,平均17.2 d。重症颅脑损伤术后早期气管切开肺部感染率和控制感染平均时间均显著低于未早期行气管切开患者(P<0.01),而感染控制率显著高于未早期切开者(P<0.05)。结论早期气管切开能有效防止重症颅脑损伤术后并发的肺部感染,是提高重型颅脑损伤救治的重要手段。Objective To study the impact of earlier period tracheotomy on preventing pulmonary infection after heavy craniocerebral injury.Methods40 patients given early tracheotomy with the craniotomy and craniectomyn time equal or less than 24 hours and 40 patients without tracheotomy（the time of tracheotomy24 hours or the patients who had not been done tracheotomy）were chosen.All the patients used the third generation ocephalothin and half-synthesis Benzylpenicillin to prevent infection.All the patients who had pulmonary infection had undertaken the the sputum cultivation test to choose sensitive medcine for treatment.ResultsThere are 52 patients occurred pneumonia and in the test group 12 of 16 pneumonia patients were cured,the time of controlling is 4 to 10 days,average 6.5 days.There are 36 patients in control group,12 of them were cured,the time of curing is 10 to 20 days,average 17.2 days.The time of infection of lung and the time to control the infection were significant shorter in patients accepted tracheotomy than who had not undertaken tracheotomy（P0.001）.The rate of controlling the infection was significant higher than who had not undertaken tracheotomy（P0.05）.ConclusionEarlier period tracheotomy can prevent the infection of lung after heavy craniocerebral injury and is an important mean to treat heavy craniocerebral injury.

关 键 词：重症颅脑损伤 气管切开术 肺部感染 

分 类 号：R651.15[医药卫生—外科学]