早期气管切开对重型颅脑损伤术后并发肺部感染的影响  

Effect of early tracheotomy on patients with pulmonary infection after severe craniocerebral injury

作　　者：许国文[1] 孙艳云 韩振波 魏玲[1] 李军[1] 陈永新 赵洪亮[1] 宋金和[1] 韩华柱 XU Guo-wen;SUN Yan-yun;HAN Zhen-bo;WEI Ling;LI Jun;CHEN Yong-xin;ZHAO Hong-liang;SONG Jin-he;HAN Hua-zhu(Department of Neurosurgery,Huanghua People′s Hospital,Huanghua Hebei 061100,China)

机构地区：[1]黄骅市人民医院神经外科

出　　处：《局解手术学杂志》2019年第8期631-634,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省卫生厅重点科技研究计划(20171196)

摘　　要：目的探讨早期气管切开对重型颅脑损伤术后并发肺部感染的影响以及生化因子的变化。方法选取2017年3月至2018年8月在我院重症监护室治疗的重型颅脑损伤患者288例,分为2组,颅脑损伤后24 h内行气管切开的患者纳入观察组,颅脑损伤24 h后行气管切开的患者纳入对照组,比较2组患者的肺部感染发生率、感染控制率、感染控制时间、c-反应蛋白(CRP)、降钙素原(PTC)的变化。结果观察组患者肺部感染率和平均控制时间均低于对照组,感染控制率高于对照组,2组比较差异有统计学意义(P<0.05);2组患者术后第1、3、7、10天的CRP与术前比较均明显增加,差异有统计学意义(P<0.05);2组患者在术后第1、3、7、10天的PCT与术前相比均明显增加,差异有统计学意义(P<0.05),在术后第7、10天,观察组PCT与对照组相比明显降低,差异有统计学意义(P<0.05)。结论对重型颅脑损伤患者在术后早期行气管切开,有助于控制肺部感染,降低肺部感染率。Objective To investigate the effects of early tracheotomy on patients with pulmonary infection after severe craniocerebral injury,and to explore the changes in biochemical factors.Methods A total of 288 patients with severe craniocerebral injury who were treated in our intensive care unit from March 2017 to August 2018 were enrolled,and they were divided into two groups.Patients underwent tracheotomy within 24 hours after craniocerebral injury were included in the observation group,and patients underwent tracheotomy 24 hours after craniocerebral injury were included in the control group.The pulmonary infection incidence,infection control rate,infection control time,changes of biochemical factors c-reactive protein(CRP)and procalcitonin(PTC)were compared between the two groups.Results The pulmonary infection incidence and average infection control time in the observation group were lower than the control group,but the infection control rate in the observation group was higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).The CRP and PCT at the 1st,3rd,7th,and 10th day after surgery in the two groups were significantly increased compared to those before the surgery,and the difference between the two groups was statistically significant(P<0.05).At the 7th and 10th day after surgery,the PCT of the observation group was significantly lower than that of the control group with statistically significant difference(P<0.05).Conclusion Early tracheotomy for patients with severe craniocerebral injury can reduce the rate of pulmonary infection.

关 键 词：早期气管切开 颅脑损伤 肺部感染 CRP PTC 

分 类 号：R651.15[医药卫生—外科学]