单纯重型创伤性颅脑损伤患者院前与院内气管插管的对比研究

The comparative study of pre-hospital and in-hospital intubation in patients with isolated severe traumatic brain injury

目的:对比院前与院内气管插管对单纯重型创伤性颅脑损伤救治的效果。方法:收集我院2013年1月至2014年12月收治单纯重型创伤颅脑损伤(GCS评分≤8分)患者72例,按照单双日法随机分为院前气管插管组(38例)和院内气管插管组(34例),比较两组患者的一般资料、气管插管完成情况、ICU住院时间、机械通气时间、急性呼吸窘迫综合征、吸入性肺炎、30 d病死率。结果:两组一般资料比较差异无统计学意义,院前插管组插管时间长、平均插管次数多、2次内插管成功率低、围插管期并发症多,两组在ICU住院时间、机械通气时间、吸入性肺炎、急性呼吸窘迫综合征、30 d病死率比较差异无统计学意义。结论:院前气管插管并发症多,操作难度大,对于无气道阻塞和呼吸衰竭的重型创伤性颅脑损伤患者,院前早期或预防性插管并没有使患者获益。

Objective To compare the effects of pre-hospital intubation and in-hospital intubation in patients with isolated severe traumatic brain injury （TBI）. Methods 72 patients with isolated severe traumatic brain injury （treated in Second People＇s Hospital of Qinzhou from January 2013 to December 2014） were randomly divided into pre-hospital intubation group （n = 38） and in-hospital intubation group （n = 34） according to the odd and even days of date of admission. General data, information of endotracheal intubation, ICU observing time, time of mechanical ventilation, acute respiratory distress syndrome, aspiration pneumonia and 30 d mortality of the two groups were compared. Results There was no significant difference between two groups in general data （P 〉 0.05）. Compared with in-hospital intubation group, pre-hospital intubation group had longer operation time, more attempts to successful intubation, lower success rate on the second attempt and more complications （P 〈 0.05）. There was no significant differences between the two groups on the data on ICU observing time, time of mechanical ventilation, acute respiratory distress syndrome, aspiration pneumonia and 30 d mortality （P 〉 0.05）. Conclusions The pre-hospital intubation was difficult to operation and brought more complications. For isolated severe traumatic brain injury patients without airway obstruction and respiratory failure, the pre-hospital intubation for early or preventive intubation offer no benefits.