重型颅脑损伤开颅术后早期气管切开对防治肺部感染的作用研究

The Impact of Earlier Tracheotomy on the Prevention and Treatment of Pulmonary Infection for the Patients with Severe Head Injury

目的研究重型颅脑损伤术后早期气管切开对防治肺部感染的影响。方法选取重型颅脑损伤经手术治疗,开颅术后≤24h行气管切开患者52例,另急诊开颅手术治疗重型颅脑损伤术后未行气管切开或切开时间>24h的患者52例。所有患者均以三代头孢及半合成青霉素静脉滴注预防感染,出现肺部感染者均行痰液培养及药敏试验,选择敏感抗生素进行治疗。结果 65例出现肺部感染,其中实验组26例,有18例控制,感染控制时间为4～12d;对照组39例,有24例控制,感染控制时间9.6～26d;重型颅脑损伤患者术后早期气管切开肺部感染和控制感染平均时间均显著低于未行早期气管切开患者;而感染控制率明显高于未早期切开者。结论早期气管切开能有效防治重型颅脑损伤术后并发肺部感染。

Objective To study the impact of earlier tracheotomy on the prevention and treatment of pulmonary infection for the patients with severe head injury.Methods The 52 patients with severe head injury（experimental group） received tracheotomy within 24h after emergency cerebrotomy,controlled by 52 patients（control group） who didn′t receive tracheotomy within 24h after emergency cerebrotomy.The third generation cephalosporin and semi-benzylpenicillin were used to prevent infection in all the patients.The patients who had lung infection were taken sputum cultivation test to choose sensitive medicine for the treatment.Results A total of 65 patients occurred pneumonia.There were 26 patients occurred pneumonia in the experimental group and 18 patients were cured.The time of infection control was 4～12d.There were 39 patients occurred pneumonia in control group,and 24 of them were cured.The time of infection control was 9.6～26d.The rate of lung infection and the time of infection were significantly lower in the experimental group than those of the control group.The rate of infection control was significantly higher in the experimental group than thatin the control group.Conclusion The pulmonary infection of the patients with severe head injury can be effectively prevented with the treatment of earlier period tracheotomy.