早期气管切开治疗重度颅脑损伤的临床效果  

Clinical effect of early tracheotomy in the treatment of severe craniocerebral injury

作　　者：梁德双 蔡慧 罗成义[2] 梁梅海 

机构地区：[1]广东省新兴县人民医院神经外科,广东新兴527400 [2]南方医科大学附属珠江医院神经外科,广州510280

出　　处：《中国当代医药》2016年第1期57-60,共4页China Modern Medicine

摘　　要：目的探讨早期应用气管切开术对重度颅脑损伤患者临床疗效、肺部感染以及预后的影响。方法选取2013年4月~2014年7月在本院诊治的122例重度颅脑损伤患者作为研究对象,按照气管切开时机分为治疗组（70例）和对照组（52例）。治疗组在伤后24 h内行气管切开,对照组则在受伤24 h后行气管切开,其余治疗方法相同。观察两组的临床疗效、神经功能缺损改善程度、肺部感染和控制情况以及预后结局。结果治疗组的总有效率为97.1%,显著高于对照组的80.8%,差异有统计学意义（P〈0.05）。两组治疗后的神经功能缺损评分显著低于治疗前,治疗组治疗后的神经功能缺损评分显著低于对照组治疗后,差异有统计学意义（P〈0.05）。治疗组的肺部感染发生率为27.1%,显著低于对照组的51.9%,差异有统计学意义（P〈0.05）。治疗组的感染控制率为68.4%,显著高于对照组的37.0%,差异有统计学意义（P〈0.05）。治疗组的感染控制时间显著短于对照组,差异有统计学意义（P〈0.05）。治疗组的死亡率为33.9%,显著低于对照组的55.6%,差异有统计学意义（P〈0.05）。结论早期给予重度颅脑损伤患者气管切开术能够有效防治肺部感染,改善患者预后,效果显著,安全性好,值得临床推广应用。Objective To explore the influence of early tracheotomy on clinical effect,pulmonary infection and prognosis of patients with severe craniocerebral injury. Methods 122 patients with severe craniocerebral injury from April 2013 to July 2015 in our hospital were selected and divided into the treatment group（70 cases） and the control group（52 cases） according to the timing of tracheotomy.The treatment group was given tracheotomy within 24 hours after injury,the control group was given tracheotomy more than 24 hours after injury,the remaining treatment was the same in both groups.The clinical effects,improvement of neurologic impairment,incidence and management of pulmonary infection,prognosis in the two groups was compared. Results The total effective rate in the treatment group was 97.1%,which was higher than 80.8% in the control group,with significant difference（P〈0.05）.The score of neurologic function impairment after treatment in the two groups was lower than that before treatment,the score of neurologic function impairment after treatment in the treatment group was lower than that in the control group after treatment,with significant difference（P〈0.05）.The incidence rate of pulmonary infection in the treatment group was 27.1%,which was lower than 51.9% in the control group,with significant difference（P〈0.05）.The control rate of infection in the treatment group was 68.4%,which was higher than 37.0% in the control group,with significant difference（P〈0.05）.The control time of infection in the treatment group was shorter than that in the control group,with significant difference（P〈0.05）.The mortality rate in the treatment group was33.9%,which was lower than 55.6% in the control group,with significant difference（P〈0.05）. Conclusion Early tracheotomy in patients with severe craniocerebral injury can effectively prevent and treat lung infection,improve the prognosis of patients,the effect is significant,safety is good,it is worthy of clinical promotion and application.

关 键 词：早期气管切开 重度颅脑损伤 肺部感染 预后 

分 类 号：R651.15[医药卫生—外科学]