早期气管切开在重症高血压脑出血患者术后的应用

Application of Early Tracheotomy for Critical Patients with Hypertensive Intracerebral Hemorrhage

目的探讨重症高血压脑出血术后患者早期气管切开的临床意义。方法选取2012年1月至2013年3月,泸州医学院附属医院神经外科收治122例重症高血压脑出血患者,其中60例患者在血肿清除术后24 h内行气管切开术纳入早期气管切开组,62例患者未行气管切开或延迟切开归为对照组。总结患者的临床资料,并比较分析两组术后肺部感染率、病死率及日常生活能力评分（ADL）。结果早期气管切开组ADLⅠ~Ⅴ级54例（90.0%）,死亡6例（10.0%）;对照组ADLⅠ~Ⅴ级47例（75.8%）,死亡15例（24.2%）。早期气管切开组疗效好于对照组,病死率显著低于对照组（P〈0.05）。早期气管切开组肺部感染26例（43.3%）,对照组肺部感染38例（61.3%）,早期气管切开组的肺部感染发生率显著低于对照组（P〈0.05）。结论重症高血压脑出血手术治疗后,早期行气管切开,可有效提高患者的治愈率,降低肺部感染率及病死率。

Objective To explore the significance and surgical indications of tracheotomy for critical patients with hypertensive intracerebral hemorrhage. Methods From Jan. 2012 to Mar. 2013,122 critical patients with hypertensive intracerebral hemorrhage admitled to the Affiliated of Luzhou Medical College were selected. Among them, 60 cases received early tracheotomy （ time ≤24 h, early tracheotomy group）, and 62 cases received no tracheotomy or delayed tracheotomy （ time 〉 24 h, control group）. The clinical data of these patients were analyzed retrospectively, and lung infective rate, mortality, activity of daily living scale （ADL） were analyzed. Results In the early tracheotomy group, follow-up assessment according to the ADL score revealed grade I -V in 54 cases（90.0% ）, 6 cases（ 10.0% ） died, lung infection was detected in 21 cases（43.3% ）. In the control group, grade I -V in 47 cases（75.8% ）, 15 cases（24.2% ） died, lung infection was detected in 38 cases（61.3% ）. There were significant differences between two groups（ P 〈 0. 05 ）. Conclusion For the patients of hypertensive intracerebral hemorrhage, early tracheotomy can reduce the lung infective rate, decrease the mortality, and improve the survival rate and life quality.