脑出血患者气管切开时机对治疗疗效及术后肺部感染的影响

Effect of the timing of tracheotomy on the efficacy and pulmonary infections in patients with encephalorrhagia

目的探讨脑出血患者气管切开时机对治疗疗效及术后肺部感染发生的影响,为脑出血的临床治疗提供参考。方法选取2014年10月-2017年5月于医院诊治的脑出血患者78例为研究对象,根据气管切开的实际时机将患者分为早期组(发病6天之内)35例和晚期组(发病6天之后)43例,患者入院后均行气管切开治疗,观察气管切开前后血氧饱和度变化、平均住院时间,术后肺部感染痰液细菌培养的结果。结果气管切开后,两组患者血氧饱和度均有所改善(P<0.05),早期组患者血氧饱和度为(98.13±1.21)%,晚期组患者为(95.85±1.04)%,早期组患者血氧饱和度改善程度优于晚期组患者(P<0.05);早期组患者平均住院时间为(49.14±14.63)d,短于晚期组患者的(58.93±22.23)d(P<0.05);两组肺部感染患者痰液检出病原菌243株,其中早期组检出103株占42.39%、晚期组检出140株占57.61%,两组感染病原菌构成比比较差异无统计学意义;早期组多重感染33例占94.29%,晚期组多重感染40例占93.02%,两组肺部感染患者感染类型比较差异无统计学意义。结论脑出血患者早期行气管切开有助于尽快改善血氧饱和度及缩短住院时间,术后肺部感染病原菌主要为革兰阴性菌为主的混合感染,气管切开时机对感染病原菌分布无明显影响。

OBJECTIVE To investigate the effect of the timing of tracheotomy on the efficacy and pulmonary infections in patients with encephalorrhagia,so as to provide references for clinical treatment of cerebral hemorrhage.METHODS The 78 cases of encephalorrhagia patients from Oct.2014 to May 2017 were selected,and were divided into early group（the onset time≤6 d,35 cases）and late group（the onset time6 d,43 cases）according to the actual timing of tracheotomy.The patients underwent tracheotomy and hematoma removal after admission.The changes of oxygen saturation before and after tracheotomy,average hospitalization time,and the results of bacterial culture of sputum from pulmonary infection after operation were observed.RESULTS After tracheotomy,the blood oxygen saturation of the two groups were improved.The oxygen saturation of the early group and the late group were（98.13±1.21）% and（95.85±1.04）%,and the improvement of the blood oxygen saturation of the early group was better than that of the late group（P〈0.05）.The average hospitalization time of the early group was（49.14±14.63）d,which was significantly shorter than（58.93±22.23）d of the late group（P〈0.05）.Totally 243 strains of pathogenic bacteria were detected in sputum of patients with pulmonary infection,including 103 strains（42.39%）in the early group and 140 strains（57.61%）in the late group.There was no significant difference in the distribution of pathogens between the two groups.There were 33 cases（94.29%）of multiple infections in the early group,and 40 cases（93.02%）of multiple infections in the late group,and there was no significant in the infection types between the two groups of patients with pulmonary infections.CONCLUSIONThe encephalorrhagia patients with early tracheotomy can improve blood oxygen saturation and shorten hospital stay as soon as possible,the main pathogenic bacteria of pulmonary infections after surgery are mainly mixed infections of gram-nega-tive bacteria,and the timing of tracheotomy has no obvious effect on the distribution of pathogenic bacteria.