36例重型颅脑损伤患者行复杂气管切开术的预后分析

Prognostic analysis of complex tracheotomy in 36 cases patients with severe head injury

目的探讨重型颅脑损伤患者并复杂气管切开术的手术特点及相关并发症的处理。方法回顾性分析2008年5月至2014年1月我院收治的36例重型颅脑损伤并复杂气管切开患者的临床资料。结果 36例中29例原发病好转后顺利拔管,2例放弃治疗带管出院,3例死于原发病,1例死于并发症,1例长期带管。严重并发症15例,其中术中窒息4例,气胸1例,皮下气肿2例,术后出血5例,术后狭窄1例,气管塌陷1例,死亡1例。结论重型颅脑损伤患者病情危重及紧急,当同时并复杂气管切开术有其特殊性,应加强认识,做好术前的检查与准备,快速评估可能的风险,选择最佳的手术时机与方法可有效减少不良后果的发生。

Objective To investigate the operation characteristics and management of related complications of complex tracheotomy in patients with severe head injury.Methods The clinical data of complex tracheotomy in 36 patients with severe head injury,admitted from May,2008 to January,2014,were retrospectively analyzed.Results Of the 36 patients,29 cases were extubated as the primary disease recovered smoothly;3 cases died of primary disease;1 case died of complications;2 cases with pipe gave up treatment after being discharged from hospital and 1 case with tube for a long time.Serious complications occurred in 15 cases including 4 cases with intraoperative suffocation,1 case with pneumothorax,2 cases with subcutaneous emphysema,5 cases with postoperative bleeding,1case with postoperative stenosis,1 case with trachea collapse and 1 death of pneumocephalus.Conclusion Patients with severe head injury are in a critical condition.It has its particularity when they have complex tracheotomy at the same time.We should strengthen the understanding,perform the preoperative examination and pre-operation preparation,rapidly assess the potential risk,choose the best operation time and the method in order to effectively reduce the risk of adverse consequences.