高血压脑出血术后早期气管切开对防止肺部感染的影响

Impact of Earlier Period Tracheotomy for the Patients of Hypertension Cerebral Hemorrhage to Prevent Infection of Lung

目的 研究高血压脑出血术后早期气管切开对防止肺部感染的影响。方法 选择高血压脑出血患者 ,出血量≥ 4 0 m l,急诊开颅手术后≤ 2 4 h气管切开患者 4 0例 ,另急诊开颅手术后未于早期气管切开 (即切开时间>2 4 h或未行气管切开的患者 ) 4 0例 ,所有患者术后均用头孢三代 ,半合成青霉素静滴预防感染 ,出现肺部感染者均行痰培养药敏试验 ,选择敏感药物进行治疗。结果 5 2例患者出现肺部感染 ,其中实验组 16例有 12例感染控制 ,感染控制时间 4～ 10 d,平均 6 .5 d;对照组 36例 ,有 12例感染控制 ,感染控制时间为 10～ 2 0 d,平均17.2 d;高血压脑出血术后早期气管切开肺部感染率和控制感染平均时间均显著低于未早期行气管切开患者(P<0 .0 1) ,而感染控制率显著高于未早期切开者 (P<0 .0 5 )。结论 早期气管切开能有效防止高血压脑出血术后并发的肺部感染。

OBJECTIVE To study the impact of earlier tracheotomy for the patients of hypertension cerebral hemorrhage to prevent infection of lung. METHODS The patients of hypertension cerebral hemorrhage (≥40ml) were chosen, who had or had not tracheotomy within 24h after they had emergency cerebrostomy. All the patients used the third generation cephalosporin and semi-synthetic benzylpenicillin to prevent infection. All the patients who had lung infection were taken sputum cultivation test to choose sensitive medicine for treatmeat. RESULTS Fifty two patients occurred pneumonia and of them 16 patients were cured, the time of controlling was 4-10 days, in average 6.5 days. There were 16 patients in control group, 12 of them were cured. Of the patients who had hypertension cerebral hemorrhage, the time of curing was 10-20 days, in average 17.2 days. The time of lung infection and the time of infection control were significant shorter than that without tracheotomy (P< 0.001). The rate of controlling the infection was significant higher than that without tracheotomy (P<0.05). CONCLUSIONS Earlier period tracheotomy could prevent the infection of lung.