早期机械通气治疗重型颅脑损伤患者的临床研究

Early mechanical ventilation in the treatment of patients with severe craniocerebral injury

目的观察早期机械通气对重型颅脑损伤的临床研究。方法选择50例ICU收治的重型颅脑损伤患者作为研究对象,采取随机抽样法分为机械通气治疗组(A组)和吸氧治疗组(B组)两组,分别给以机械通气(每天FiO2100%2 h)和吸氧(低流量)治疗,每天监测患者生命体征、颅内压(ICP)、C一反应蛋白(CRP)、PO2、PCO2、氧合指数(PaO2/FiO2),比较两组患者脑水肿消退程度、脑水肿消退时间、平均ICU住院时间、死亡率的变化。结果两组治疗后比较.机械通气治疗组较吸氧治疗组生命体征更趋于稳定。各项监测指标提示机械通气治疗组PO2及氧合指数更佳,脑水肿消退快、程度轻,脑水肿持续时间短,c反应蛋白明显下降,说明颅脑损伤逐步恢复。表3示2周内死亡率比较.机械通气治疗组较吸氧治疗组明显下降。机械通气治疗组与吸氧治疗组比较,P<0.05,有统计学意义。结论早期机械通气能减轻脑水肿,降低颅内压,改善脑循环,改善脑供氧,防止氧自由基的产生减轻炎症损伤.防止并发症。降低病死率及ICU住院时间。

Objective：To investigate the role of early mechanical ventilation in the treatment of patients with severe eraniocerebral injury. Methods ： 50 patients with severe cranioeerebral injury were divided into the treatment group and con- tml group. The oxygen saturation （SaO2 ）, CRP, oxygen partial pressure （PaO2 ）, partial pressure of carbon dioxide （PaCO2）, blood pressure（BP）, heart rate （HR）, GCS score and prognosis in two groups were compared. Results： The differences in SaO2, CRP, PaO2 and PaCO2, between treatment and control group were statistically significant after treat- ment（P 〈0.05. Prognosis in the treatment group was better than that in the control group after two weeks followup. Con- clusion： Early mechanical ventilation is effective in reduction of intracranial pressure and cerebral edema. It can also de- crease complications and improve the quality of life in patients with severe craniocerebral injury.