改良经皮气管旋切术影响急性脑卒中昏迷早期意识水平及预后的研究

Evaluate the effect of percutaneous dilational tracheostomy to the early awareness and prognosis of acute brain stroke coma patients

目的:评价改良经皮气管旋切术对急性脑卒中昏迷患者早期意识水平及预后的影响,为其临床应用提供依据。方法:将62例急性脑卒中后昏迷需行气管切开的患者随机分为常规气管切开(T)组及经皮气管旋切术(PDT)组,以脑电双频指数(BIS)、格拉斯哥评分(GCS)比较2组患者48h内的意识水平,以改良的Rankin量表(mRS)评价预后,并对治疗过程进行安全性比较。结果:2组患者的BISmean和GCSmean差异无统计学意义,但PDT组的BIS波动范围低于T组(P<0.05),且mRS预后优于T组,手术过程丙泊酚用量、手术时间、术中出血量、切口大小等方面,PDT组优于T组(P<0.05),且不良反应少。结论:经皮扩张气管切开术较常规气管切开术能更好地改善急性脑卒中昏迷后早期意识水平,且其安全性好,术后并发症少,预后良好。

Objective：Evaluate the effect of percutaneous dilational tracheostomy to the early awareness level and prognosis of acute brain stroke coma patients and provide the basis for its clinical application.Method：62cases of acute cerebral apoplexy patients were randomizedly divided into conventional tracheostomy group（T）and percutaneous dilational tracheostomy（PDT）group.After the clinical intervention,early level of consciousness of patients of two groups were compared with electrical double frequency index（BIS）and glasgow score（GCS）within48hours.Prognosis was evaluated with the modified Rankin scale（mRS）.And the security of treatment had been compared.Result：There was no statistically significant difference between BISmean and GCSmean of the two groups（P〈0.05）.But wave range of BIS of group PDT was lower than it of group T（P〈0.05）.And prognosis of group PDT was better than that of group T.In the process of operation,dosage of propofol,operation time,intraoperative blood loss,surgical incision size of group PDT were better than those of group T.And adverse reactions of group PDT was fewer than that of group T（P〈0.05）.Conclusion：Compared to traditional tracheotomy,PDT can better improve early awareness of the acute brain stroke coma patients.It has better security,less postoperative complications and better prognosis.