管切开时机对老年颅脑损伤患者肺部感染影响的研究

The effect of tracheotomy timing in elder patients who got traumatic brain injury： a retrospective study

目的探讨选择在不同气管切开时机的拔管率、肺部感染发生率和死亡率的差异。方法选取老年颅脑损伤患者41例，收集患者的年龄、性别、格拉斯哥昏迷评分（GCS）、发病至气切的时间、平均置管时间及拔管率、预后。其中颅脑损伤后72h内气切者有25例，称为A组，72h以后气切者有16例，称为B组。结果在性别（P=0．185）、年龄（P=0．078）、昏迷指数水平GCS（P=0．922）差异无统计学意义的情况下，其病死率差异无统计学意义（P=0．354），拔管率差异无统计学意义（P=0．493），肺部感染率差异（P=0．033），A组小于B组。结论老年颅脑损伤患者，在具有气管切开手术指征的情况下，颅脑外伤后72h内行气管切开术可降低其肺部感染率。

Objective To discuss the difference of wean rate, pneumonia rate and mortality between different tra- cheotomy timing. Methods Forty-one elderly patients with traumatic brain injury were divided into two groups： tracheotomy during 72 hours group （group A, n=25） and tracheotomy after 72 hours group （group B, n= 16）. Age, sex, GCS, length of time before undergoing tracheotomy, weaning rate were assessed and analyzed. Results A total of 41 patients （28 men and 13 women） were included. There were no differences in age （P=0.078）, sex （P=0.185）, and GCS （P=0.922） between the two groups. Patients in group A had lowerpneumonia rate, compared with group B （P=0.033）. Conclusion Patients with traumatic brain injury, undergoing tracheotomy in 72 hours, have a lower pneumonia rate.