基底节区脑出血术后中度昏迷患者超早期气管切开的临床疗效  

Clinical efficacy of ultra-early tracheotomy on patients with moderate coma after operation of basal ganglions hemorrhage

作　　者：岑庆君[1] 高忠恩[1] 殷万春[1] 彭立基[1] 冯荣亮[1] 黎海滨[1] 

机构地区：[1]肇庆市第一人民医院神经外科,广东肇庆526021

出　　处：《岭南现代临床外科》2012年第4期362-363,368,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨基底节区脑出血术后中度昏迷患者行气管切开的手术时机以及临床疗效。方法回顾性分析我科2007年1月至2011年3月术后处中度昏迷的自发性基底节区脑出血63例。手术当天行气管切开的有27例(超早期组),其余36例在开颅手术3天以后行气管切开(晚期组),比较两组之间继发性肺部感染的发生率、术后意识恢复清醒的时间、术后3个月的日常生活能力(ADL)。结果本组63例均治愈出院。超早期组开颅术后清醒恢复时间平均为18.6d,而晚期组平均时间为27.5d。超早期组患者术后3个月的日常生活能力(ADL)达Ⅱ级19例,占70.4%(19/24);而ADLⅢ～Ⅳ级8例;站29.6%(8/27)。晚期组术后3个月ADL达Ⅱ级16例,占本组44%(16/36),ADLⅢ级20例,占本组55.6%(20/36)。超早期组的继发肺部感染率66.7%(18/27);而晚期组为91.7%(33/36)。结论超早期气管切开术应用于基底节脑出血术后中度昏迷患者其有明显改善预后作用。Objective To explore the operative timing and clinical effects of tracheotomy on patients？ with moderate coma after operation of basal ganglions hemorrhage. Methods From January 2007 to March 2011, 63 cases with moderate coma after operation of spontaneous basal ganglions hemorrhage were analyzed retrospectively. Among them, 27 cases underwent tracheotomy on operative day （ultra early group）,the other 36 cases underwent tracheotomy on three days after craniotomy（late stage group）. The incidence of secondary pulmonary injection,time of postoperative recovered consciousness,activity of daily life （ADL） in 3 months after operation were compared between two groups. Results In this group, all cases were cured to discharge from hospital. The average time of postoperative recovered consciousness was 18.6 days and 27.5days in the ultra early group and late stage group respectively. In the ultra early group, the Ⅱ grade and Ⅲ -IV grade of activity of daily life of postoperative three months were in 19 cases（70.4） and 8 cases（29.6） respectively.In the late stage group the Ⅱ grade and Ⅲ grade were in 16 cases （44%） and 20 cases （55.6%）respectively. The incidences of secondary pulmonary infection were 66.7%（ 18 cases） and 91.7%（33 cases） in the ultra early group and late stage group respectively. Conclusions Ultra early tracheotomy possesses improved prognosis significantly in the use of the patients with moderate coma after operation of basal ganglions hemorrhage.

关 键 词：脑出血 中度昏迷 超早期 气管切开 临床疗效 

分 类 号：R655.3[医药卫生—外科学]