间歇性停用肌肉松弛剂对亚低温治疗的颅脑损伤患者复温后肺部感染的影响

Effects of Intermittent Drug Withdraw of Muscle Relaxants in Reducing Incidence of Ventilator-associated Pneumonia on Brain Injury Patients Treated with Rewarming after Mild Hypothermia

目的探讨间歇性停用肌肉松弛剂降低重型颅脑损伤患者在亚低温治疗复温后肺部感染发生率的作用。方法便利抽样法选取2007年10月至2010年11月在上海市第七人民医院神经外科进行亚低温治疗的重型颅脑损伤患者90例为研究对象,按随机数字表将其分为观察组(n=49)和对照组(n=41),两组患者均采用常规的亚低温治疗方法。观察组患者在亚低温治疗期间根据医嘱每6h停用肌肉松弛剂罗库溴铵30min,对照组患者按照常规持续使用。观察两组患者在复温1周后肺部感染的发生率。结果两组患者亚低温治疗复温1周后肺部感染的发生率分别为16.3%、46.3%,对照组高于观察组,差异有统计学意义(P<0.01)。结论间歇性停用肌肉松弛剂可降低亚低温治疗的重型颅脑损伤患者复温后肺部感染的发生率。

Objective To investigate the effects of intermittent drug withdraw of muscle relaxants in reducing the incidence of pulmonary infection on patients with severe craniocerebral injury under the treat- ment of rewarming after mild hypothermia. Methods From October 2007 to November 2010,90 patients with severe craniocerebral injury requiring mild hypothermia treatment who had not got ventilator- associated pneumonia were enrolled. They were randomly divided into intervention group （n = 49） and control group （n = 41）. All the patients were treated with conventional mild hypothermia therapy. The patients in the intervention group discontinued muscle relaxants for 30 minutes per 6 hours according to the medical advice, and the control group was treated with conventional therapy constantly. The incidence of lung infection comparison was been made between the two groups under the rewarming treatment after mild hypothermia for one week. Results The incidence of lung infection under treatment of rewarming after mild hypo- thermia for one week in the intervention group （16.3%） was significantly lower than that in the control group （46.3%） （P〈O. 01）. Conclusion Intermittent drug withdraw of muscle relaxants can reduce the incidence of lung infection on patients with severe craniocerebral injury under treatment of rewarming after mild hypothermia.