早期气管切开术治疗颅脑外伤与脑出血患者的效果研究  

Study on the effect of early tracheotomy in the treatment of patients with craniocerebral trauma and cerebral hemorrhage

作　　者：齐红芳 QI Hong-fang(Boxing County People's Hospital,Binzhou 256500,China)

机构地区：[1]博兴县人民医院,256500

出　　处：《中国实用医药》2022年第25期53-56,共4页China Practical Medicine

摘　　要：目的研究早期气管切开术治疗颅脑外伤与脑出血患者的效果。方法90例颅脑外伤与脑出血患者,按照随机数字表法分为对照组和观察组,每组45例。观察组患者实施早期(发病24 h内)气管切开术治疗,对照组患者发病24 h后实施气管切开术治疗。比较两组患者治疗前后的脑氧代谢指标[颈内静脉球氧饱和度(CjvO_(2))、脑动脉-静脉氧浓度差(DA-jvO_(2))、脑氧摄取率(CERO_(2))]、血清神经功能指标[神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、中枢神经特异性蛋白(S100-β)]、美国国立卫生研究院卒中量表(NIHSS)评分及临床疗效、并发症发生情况、死亡情况。结果治疗后,两组患者的CjvO_(2)、CERO_(2)水平均高于本组治疗前,DA-jvO_(2)水平低于本组治疗前,且观察组患者的CjvO_(2)(100.17±6.30)ml/L、CERO_(2)(43.78±5.46)%均高于对照组的(94.40±5.53)ml/L、(39.07±4.22)%,DA-jvO_(2)(49.92±2.57)ml/L低于对照组的(54.03±3.76)ml/L,差异具有统计学意义(P<0.05)。治疗后,两组患者的血清NSE、GFAP、S100-β及NIHSS评分均低于本组治疗前,且观察组患者的血清NSE(5.20±0.57)μg/L、GFAP(2.20±0.23)ng/L、S100-β(0.13±0.02)ng/ml及NIHSS评分(4.28±1.00)分均低于对照组的(7.96±0.95)μg/L、(4.37±0.56)ng/L、(0.32±0.06)ng/ml、(7.38±1.62)分,差异具有统计学意义(P<0.05)。观察组患者的治疗总有效率为93.33%,明显高于对照组的75.56%,差异具有统计学意义(P<0.05)。观察组患者的并发症发生率4.44%及死亡率0均显著低于对照组的22.22%、11.11%,差异具有统计学意义(P<0.05)。结论早期气管切开术应用于颅脑外伤与脑出血患者治疗中具有较好的效果,有助于脑氧代谢及神经功能的改善,预后效果良好。Objective To study the effect of early tracheotomy in the treatment of patients with craniocerebral trauma and cerebral hemorrhage.Methods A total of 90 patients with craniocerebral trauma and cerebral hemorrhage were divided into control group and observation group according to random numerical table,with 45 cases in each group.Patients in the observation group were treated with early tracheotomy (within24 h of onset),and patients in the control group were treated with tracheotomy after 24 h of onset.Both groups were compared in terms of cerebral oxygen metabolism indexes[internal jugular venous oxygen content (CjvO_(2)),cerebral arterial venous oxygen content difference (DA-jvO_(2)),cerebral extraction rate of oxygen (CERO_(2))],serum neurological function indexes[neuron-specific enolase (NSE),glial fibrillary acidic protein (GFAP),central nervous system-specific protein (S100-β)]and National Institutes of Health Stroke Scale (NIHSS)scores before and after treatment,clinical efficacy,occurrence of complications,and mortality.Results After treatment,the levels of CjvO_(2) and CERO_(2) in the two groups were higher than those before treatment in this group,and the level of DA-jvO_(2) was lower than that before treatment in this group;the CjvO_(2)(100.17±6.30) ml/L and CERO_(2)(43.78±5.46)%in the observation group were higher than (94.40±5.53) ml/L and (39.07±4.22)%in the control group;the DA-jvO_(2)(49.92±2.57) ml/L in the observation group was lower than (54.03±3.76) ml/L in the control group;the differences were all statistically significant (P<0.05).After treatment,the serum NSE,GFAP,S100-β and NIHSS scores of the two groups were lower than those of this group before treatment;the serum NSE (5.20±0.57)μg/L,GFAP (2.20±0.23) ng/L,S100-β (0.13±0.02) ng/ml and NIHSS score (4.28±1.00) of the observation group were lower than (7.96±0.95)μg/L,(4.37±0.56) ng/L,(0.32±0.06) ng/ml,(7.38±1.62) points of the control group;the differences were all statistically significant (P<0.05).The total effective rat

关 键 词：颅脑外伤 脑出血 早期气管切开术 预后 

分 类 号：R651.15[医药卫生—外科学] R743.34[医药卫生—临床医学]