早期气管切开治疗老年重型颅脑损伤的疗效分析及对预后的影响

Effect of early tracheotomy on severe traumatic brain injury in elderly patients and its influence on prognosis

目的探讨早期气管切开治疗老年重型颅脑损伤(sTBI)的临床效果及对患者预后的影响。方法选取解放军总医院第七医学中心神经外科自2016年2月至2018年1月收治的106例sTBI老年患者作为研究对象,根据随机数字法分为对照组和观察组,每组53例。2组患者采用相同的治疗方案,对照组在损伤后>24 h行气管切开术,观察组在损伤后<24 h行气管切开术。比较2组患者治疗效果、血气指标变化、住院情况、肺部感染率及病死率。结果观察组患者机械通气时间、ICU住院时间、总住院时间和控制感染时间均少于对照组,差异具有统计学意义(P<0.05)。观察组肺部感染发生率显著低于对照组,而感染控制率显著高于对照组,差异有统计学意义(P<0.05)。2组治疗后48 h的PaO2、PaCO2、SpO2、PaO2/FiO2水平与治疗前比较,差异均有统计学意义(P<0.05),观察组治疗后48 h的PaO2、SpO2和PaO2/FiO2水平高于对照组,差异有统计学意义(P<0.05),PaCO2水平显著低于对照组,差异有统计学意义(P<0.05)。2组患者GOS评分、病死率比较,差异均无统计学意义(P>0.05)。结论伤后<24 h行早期气管切开更有利于改善老年重型颅脑患者低血氧症、通气功能和脑组织缺氧,降低肺部感染发生率,缩短住院时间,值得推广应用。

ObjectiveTo explore the clinical effect of early tracheotomy in the treatment of severe traumatic brain injury （sTBI） in the elderly and its influence on blood gas index, infection and prognosis.MethodsOne hundred and six elderly patients with sTBI admitted to our hospital from 2016 to 2018 were randomly divided into control group and observation group, 53 cases in each group. All patients were treated with the same basic treatment. The control group received tracheotomy more than 24 h after injury, while the observation group received tracheotomy less than 24 h after injury. The effects of treatment effect, blood gas index changes, hospitalization, pulmonary infection rate and mortality were compared between the two groups.ResultsThe duration of mechanical ventilation, ICU hospitalization, total hospitalization time and infection control time in the observation group were significantly less than those in the control group （P〈0.05）. The incidence of pulmonary infection in the observation group was significantly lower than that in the control group, while the infection control rate was significantly higher than that in the control group, the difference was statistically significant （P〈0.05）. The levels of PaO2, PaCO2, SpO2 and PaO2/FiO2 at 48 h after treatment in both groups were significantly different from those before treatment （P〈0.05）. The levels of PaO2, SpO2 and PaO2/FiO2 in the observation group were significantly higher than those in the control group 48 h after treatment （P〈0.05）, and PaCO2 levels were significantly lower than those in the control group （P〈0.05）. There was no significant difference in the distribution of GOS scores between the two groups （P〉0.05）. There was no significant difference in mortality between the observation group and the control group （P〉0.05）.ConclusionEarly tracheotomy less than 24 h after injury is more conducive to improve hypoxemia, ventilation function and brain tissue hypoxia in elderly patients with sTBI, reducing the incidence of pulmonary infection and shortening hospitalization time. It is worth popularizing and applying.