气管切开时机对严重颅脑创伤患者肺部感染救治效果的影响

Influence of Tracheostomy Timing on Pulmonary Infection and Treatment of Patients with Severe Traumatic Brain Injury

【目的】探讨重型颅脑创伤患者气管切开时机对肺部感染救治效果的影响。【方法】对136例重型颅脑创伤行气管切开治疗患者，根据气管切开时机分为早期组（具有气管切开指征后10h内予以切开）79例和延迟组（具有气管切开指征后≥10h实施气管切开）57例，对比两组患者实施气管起开前后的血气指标、肺部感染评分（CPIS）、机械通气时间及治疗结局等指标。【结果】早期组气管切开前动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血氧饱和度（SaO2）值均显著的优于延迟组；早期组气管切开24h后PaO2、PaCO2、SaO2值，切开前与切开24h后的前后差值均显著高于延迟组，且差异有显著性（P〈0．05）。早期组气管切开后d7、d28的CPIS评分均显著低于延迟组（P〈0．05）。早期组的肺部感染率、机械通气时间、ICU治疗时间、住院时间均显著的低于延迟组（P〈0．05）；早期组和延迟组患者的28d病死率相比较差异无显著性（P〉0．05）。【结论】重型颅脑创伤患者在具有气管切开指征后应该及时予以气管切开，有利于改善患者的血气指标、降低肺部感染率、缩短ICU治疗时间及住院时间。

[Objective]To investigate the effect of tracheostomy timing on pulmonary infection and treatment of patients with severe traumatic brain injury. [Methods]136 cases of severe traumatic brain injury tracheostomy patients in our neurosurgery hospital were analyzed retrospectively. The cases were divided into two groups based on the time of tracheostomy the early tracheostomy group （having a tracheostomy within 10h） with 79 cases, and the delayed group （having tracheostomy ≥10 h）with 57 cases. Blood gas before and after tracheostomy, pulmona- ry infection score （CPIS）, duration of mechanical ventilation, treatment outcomes, and other indicators were com- pared between the two groups. [Results]In the early tracheostomy group, PaO2 , PaCO2, and SaO2 values were significantly better than the levels in the delayed group （ P 〈0.05）. 24 hours after tracheostomy, the PaO2, PaCO2 , and SaO2 levels were still significantly higher than the levels in the delayed group（ P 〈0.05）. 7d and 28d after tracheostomy, CPIS scores were significantly lower in the early group than in the delayed group （ P 〈0.05）. Lung infection rates, mechanical ventilation time, ICU treatment time, and duration of hospitalization were all sig- nificantly lower in the early group than in the delayed group （ P 〈0.05）. 28d after tracheostomy,the differences in mortality rates between the two groups were not statistically significant （ P 〉 0.05 ）. [Conclusion]Tracheostomy done on severe traumatic brain injury patients should be performed as early as possible, as it will improve the pa tient＇s blood gas, reduce lung infection, shorten ICU stay, and decrease hospitalization period.