气管切开术在严重创伤患者救治中选择时机的分析

Optimal time of tracheostomy for patients with severe trauma

目的分析早期行气管切开术在救治严重创伤患者的相关指标及临床价值。方法收集我科在2002～2007年行气管切开术的293例严重创伤患者（ISS评分≥25分），伤后1周内行气管切开术为早期组，〉1周为晚期组，分析比较两组患者的相关指标。结果早期组使用机械通气时问（9．83±1．37）天，晚期组（19．28±1．65）天（P〈0．01）；早期组在ICU治疗时间（13．94±1．25）天，晚期组（24．32±1．51）天（P〈0．01）；早期组总住院时间（78．17±12．32）天，晚期组（83．53±10．26）天（P〉0．05）；早期组肺部感染率16．4％，晚期组17．1％（P〉0．05）；早期组死亡率21．2％，晚期组18．3％（P〉0．05）。结论在救治严重创伤患者时，应根据患者的病情适时早期选择气管切开术，可缩短患者使用机械通气的时问和在ICU的治疗时间，但在肺部感染率、总住院时间以及死亡率上，时机选择的早晚则无相关性。

Objective To analyze the outcomes of early tracheostomy for patients with severe trauma. Methods The clinical data of 293 patients with severe trauma （ ISS ≥25 ） received tracheostomy were collected from 2002 to 2007. Tracheostomy performed within a week after injury was taken as early group ;while tracheostomy performed 〉 1 week after injury was taken as late group. The time of mechanical ventilation,ICU stay, in-hospital stay, the rate of pulmonary infection and mortality between early and late tracheostomy patients were compared. Results The duration of mechanical ventilation was （9.83 ± 1.37 ） days in early group while （ 19.28 ± 1.65 ） days in late group （ P 〈 0.01 ）. The length of ICU stay in early group and late group was （ 13.94 ± 1. 25 ） days and （ 24.32 ± 1.51） days respectively（P 〈0.01）. The in-hospital stay in early group and late group was （78.17 ± 12.32} days and （ 83.53 ± 10.26 ） days respectively [ P 〈 0.05 ）. The rate of pulmonary infection in early group was 16.4% versus 17.1% in late group（ P 〈 0.05 ）. The mortality of early group was 21.2% versus 18.3% in late group（ P 〈 0.05 }. Conclusion The time of tracheostomy in severe trauma patients should take aecount of patients ＇ s condi- tion. Early tracheostomy （ ≤7 days ） in severe trauma patients can reduce the duration of meehanical ventilation and the length of ICU stay.