重型颅脑外伤急诊超早期气管切开的价值

Clinical Value of Ultra-early Tracheostomy on Emergent Treatment of Severe Traumatic Brain Injury

目的探讨重型颅脑损伤后急诊气管切开的时机。方法回顾分析我科89例重型颅脑损伤病例,其中39例行超早期急诊气管切开(时间≤2h);50例未行急诊超早期气管切开或延迟行气管切开(时间>2h)。比较两者的病死率及肺部感染发生率。结果39例超早期急诊气管切开者死亡9例,肺部感染6例;50例延迟气管切开者死亡24例,肺部感染21例。两者比较均有显著性差异(P<0.05)。结论对重型颅脑损伤患者估计近期不能清醒、呼吸道有梗阻、肺部痰多不易排出及合并多发伤者早期急诊气管切开,可减少肺部感染,提高治愈率和生存率。

Objective To discuss the opportunity selection of emergent tracheostomy in the patients with severe craniocerebral injury. Methods The recorded data of 89 patients with severe traumatic brain injury were divided into two groups and retrospectively analyzed. The patients （ Group A, n = 39） underwent ultra-early emergent tracheostomy within two hours, and the other patients （ Group B, n = 50） didn＇ t receive ultra-early emergent tracheostomy or underwent delayed tracheostomy （ ~〉2 hours）. The rates of fatality and pulmonary infection were compared between the two groups. Results As a result, nine patients in Group A and 24 in Group B died, their difference in fatality rate was significant （ P 〈0.05） , and six patients in Group A and 21 in Group B suffered pulmonary infection, their difference was also significant （ P 〈 0.05）. Conclusion If the patients with severe traumatic brain injury have one of the abnormal conditions such as coma without consciousness recently, overmuch sputum or obstruction in respiratory tract and multiple injuries, early emergent tracheostomy should be performed and intensive care should be conducted so as that their pulmonary infectious complication can be decreased and their cure rate and survival rate can be increased significantly.