早期机械通气对重型颅脑损伤患者预后的影响

Influence of early-stage mechanical ventilation on the prognosis of patients with severe craniocerebral injury

目的探析早期机械通气在重型颅脑损伤患者中的应用效果及对预后的影响。方法选择本院2010年5月~2013年10月收治的74例重型颅脑损伤患者,将患者分为两组。首先给予两组患者相应手术治疗及抗感染、营养支持、止血、降颅压、脱水等常规治疗。对照组采取常规机械通气,观察组行早期机械通气,比较两组的机械通气时间、致残率、病死率、治疗前与1周后神经功能缺损情况。结果观察组的机械通气时间为（92.6±32.1）h,明显短于对照组（P〈0.05）;致残率为38.5%,低于对照组的60.0%（P〈0.05）;病死率为12.8%（5/39）,与对照组的14.3%比较差异无统计学意义（P〉0.05）。观察组治疗前的SSS评分为（37.6±5.2）分,与对照组比较,差异无统计学意义（P〉0.05）。1周后降低至（24.6±4.1）分,与治疗前、对照组比较差异有统计学意义（P〈0.05）。结论早期机械通气可显著减轻患者的神经功能缺损情况,缓解脑部缺氧、缺血状态,降低致残率,改善预后,应用效果显著。

Objective To explore the application effect and prognosis of influence of early-stage mechanical ventilation in patients with severe craniocerebral injury. Methods From May 2010 to October 2013,74 patients with severe craniocerebral injury admitted into our hospital were selected and they were divided into the two groups.Regular therapies like corresponding operative treatment,anti-inflammation, nutrition support,bleeding stanching,intracranial pressure reducing,and dehydration were provided.In the control group,regular mechanical ventilation was adopted, while early-stage mechanical ventilation was applied in the observation group. Time of mechanical ventilation,disability rate,mortality rate,and neurologic impairment before and after one-week treatment were compared in the two groups. Results In the observation group,the time of mechanical ventilation [（92.6 ±32.1） h] was shorter than that in the control group（P〈0.05）.The disability rate in the observation group（38.5%） was lower than that in the control group（60.0%）（P〈0.05）.Mortality rate was 12.8%（5/39） and 14.3%（5/35） in the observation group and control group respectively,which didn′t display statistical difference（P〉0.05）.The score of SSS before treatment was（37.6±5.2） points in the observation group,and didn′t show statistical difference in comparison with that in the control group（P〉0.05）.After one-week treatment,the score decreased to（24.6±4.1） points and there was a statistical difference compared with before treatment and the control group（P〈0.05）. Conclusion Early-stage mechanical ventilation can remarkably alleviate patient′s neurologic impairment,relieve cerebral anoxia and ischemia,decrease disability rate,improve prognosis,and obtains a notable application effect.