院前气管插管与颅脑创伤术后肺部感染的关系  

The relationship between prehospital endotracheal intubation and the postoperative pulmonary infection in patients with traumatic brain injury

作　　者：王辉[1] 花嵘[1] 江小伟[2] 郭晓霞[3] 王尚静 李威[1] 

机构地区：[1]中国人民解放军第九七医院急诊科,江苏省徐州221000 [2]中国人民解放军第九七医院脑外科,江苏省徐州221000 [3]北京第二炮兵后勤部卫生部

出　　处：《中华急诊医学杂志》2015年第12期1353-1356,共4页Chinese Journal of Emergency Medicine

基　　金：南京军区创新项目（ZD13）;南京军区创新项目（09MA036）;江苏省麻醉学重点实验室开放课题（KJS1103）

摘　　要：目的 探讨重型颅脑损伤患者院前进行气管插管与其术后肺部感染的关系.方法 回顾分析解放军第九七医院2007年1月至2012年12月的284例重型颅脑损伤患者的临床资料,根据插管的时间分为院前气管插管组和院内气管插管组.分析两组患者中术后出现肺部感染的发生率、发生时间的先后、治疗时间的长短.结果 院前气管插管组的术后肺部感染率为38.0％,院内气管插管组的术后肺部感染率为25.2％;院前气管插管组发生肺部感染时间为入院后第（9.9±0.6）天,院内气管插管组发生肺部感染时间为入院后第（11.6±0.3）d;院前气管插管组的术后肺部感染治疗时间为（21.2±7.2）d,院内气管插管组的术后肺部感染治疗时间为（14.5±9.0）d;与院内气管插管组相比,院前气管插管组的术后肺部感染的发生率高（P＜0.05）、发生时间早（P＜0.05）、治疗时间长（P＜0.01）.结论 院前气管插管的重型颅脑外伤患者易于并发肺部感染,插管操作避免气道损伤和细菌污染,可能有助于减少术后肺部感染并发症.Objective To investigate the impacts of prehospital endotracheal intubation on postoperative pulmonary infection in the patients with severe traumatic brain injury.Methods Retrospectively, the clinical data of 284 patients with severe traumatic brain injury admitted in the 97th Hospital of PLA from July 2007 to December 2012 were analyzed.The patients were classified into two groups according to the timing of endotracheal intubation, namely, prehospital intubation group and admission intubation group.The postoperative pulmonary infection incidence, occurrence time, and the duration of treatment of the two groups were studied.Results The incidences of postoperative pulmonary infection in patients intubated before and after admission were 38.0% and 25.2% respectively.Pulmonary infection occurred in the prehospital intubation group was at the （9.9 ± 0.6） d after admission, and in the admission intubation group was at the （11.6 ± 0.3） d after admission.The duration of treatment for postoperative pulmonary infection was （21.2 ± 7.2） days and （14.5 ± 9.0） days respectively.Compared with the patients intubated after admission, patients intubated before admission suffered higher incidence （P 〈 0.05）, earlier onset （P 〈 0.05）, and longer treatment duration of pulmonary infection （P 〈 0.01）.Conclusions Severe traumatic brain injury patients with prehospital endotracheal intubation are more susceptible to pulmonary infection.Avoiding the tracheal injury and bacterial contamination in the procedure could reduce the incidence of pulmonary infection.

关 键 词：创伤 脑损伤 肺部感染 气管插管 院前 手术后 并发症 预防 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]