高血压脑出血术后超早期气管切开的临床意义

Clinical significance of ultra-early period tracheotomy for the patients with hypertensive cerebral hemorrhage

目的探讨高血压脑出血手术后超早期气管切开的时机。方法回顾分析我科89例高血压脑出血手术后病例,其中39例行超早期气管切开(时间≤2 h);50例未行超早期气管切开或延迟行气管切开(时间>2 h)。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)。结论对高血压脑出血手术后患者估计近期不能清醒、呼吸道有梗阻、肺部痰多不易排出者行超早期气管切开,能有效防治肺部感染等多种并发症,促进脑功能恢复,提高手术治愈率,降低病死率及提高患者生存质量。

Objective To investigate the ultra-early tracheotomy timing for hypertensive intracerebral hemorrhage after surgery. Methods 89 cases of hypertensive intraccrebral hemorrhage after surgery of our department were analyed retrospectively. Among them, 39 cases received super- early tracheotomy （time ≤ 2 h, Group A） and 50 cases were without ultra-early or delayed tracheotomy tracheotomy （time 〉2 h, Group B）. The mortality and incidence of pulmonary infection were compared between 2 groups. Results 9 cases died and 6 cases had pulmonary infection in Group A,respectively; 24 cases died and 21 cases had pulmonary infection in Group B. There are significant difference between two groups（P〈0.05）. Conclusions Ultra-early tracheotomy is suitable to postoperative hypertensive cerebral hemorrhage patients with estimating recent impossible consciousness, respirtory trct obstruction the patient of difficult discharged sputum. It would effectively prevent and treat pulmonary infection, promote the recovery of brain function, improve surgical cure rate and quality of survival and reduce mortality.