重型创伤性脑损伤早期气管切开的应用价值  

Application value of early tracheotomy for severe craniocerebral injury

作　　者：廖开友[1,2] 王胜强 徐燕[1,2] 

机构地区：[1]重庆市肿瘤研究所 [2]重庆市肿瘤医院综合科,重庆400030

出　　处：《局解手术学杂志》2013年第5期515-517,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨早期气管切开在重型颅脑损伤中的应用价值。方法我院2008年6月至2011年6月收治重型颅脑损伤患者80例,按照其气管切开时间不同分为早期气管切开(ET)组和晚期气管切开(LT)组,观察治疗前后血气分析、各时间指标以及并发症的发生率和病死率等,对比其疗效。结果治疗后ET组患者PaCO2、DO2、VO2以及PaO2水平明显优于LT组(P<0.05);ET组患者其PDT后机械通气时间、抗生素使用天数、住院时间等明显少于LT组(P<0.05);ET组患者其ALI或ARDS、难治性肺炎、MODS的发病率以及重残及死亡率明显少于LT组(P<0.05)。结论重型颅脑损伤患者行早期气管切开可以明显缩短机械通气时间,改善患者的肺通气状态,降低并发症的发生率和病死率,可显著改善患者的预后。Objective To investigate the value of early tracheotomy for severe craniocerebral injury. Methods 80 cases of severe craniocerebral injury patients were admitted into our hospital from June 2008 to June 2011, and they were divided into the ET group （early tracheostomy） and the LT group （late tracheostomy） according to different time of tracheotomy. Blood gas were analysed before and after the treatment, and time indexs, incidence of complications and fatality rate were observed in order to compare the curative effect. Results After the treatment, PaCO2 ,DO2 ,VO2 and PaO2 levels in ET group were significantly better than that of LT group （P 〈0.05）. Duration of me- chanical ventilation, antibiotic use and hospitalization time of ET group after PDT were obviously less than LT group （ P 〈 0.05 ）. ALI or ARDS, refractory pneumonia, MODS morbidity, mortality and severe disability of ET group were significantly less than LT group （ P 〈 0.05 ）. Conclusion Early tracheotomy can shorten the duration of mechanical ventilation for severe craniocerebral injury patients, and it can improve the ventilatory status and reduce the incidence of complications and mortality rate, which means a significant improvement of the prognosis.

关 键 词：颅脑损伤 气管切开术 早期治疗 

分 类 号：R651.15[医药卫生—外科学]