早期气管切开对重型颅脑损伤患者肺部感染及HMGB-1、esRAGE水平的影响

Effects of early tracheotomy on pulmonary infection and levels of HMGB-1 and esRAGE in patients with severe craniocerebral injury

目的探讨早期气管切开对重型颅脑损伤患者肺部感染及血清高迁移率族蛋白-1(HMGB-1)、内源性分泌型晚期糖基化终产物受体(esRAGE)水平的影响。方法将80例重度颅脑损伤患者随机分成早期组和对照组,两组患者均接受同样的基础治疗方案,早期组患者在入院后24h内进行气管切开。对照组患者在入院后24h后进行气管切开。比较两组患者肺部感染的发生率,比较已发生肺部感染患者的感染控制率、病死率、感染控制时间及气管切开前及手术3d后血清HMGB-1、esRAGE水平。结果早期组患者肺部感染发病率(62.5%)低于对照组患者(85.0%),差异有统计学意义(χ^2=5.230,P<0.05);早期组中肺部感染患者的感染控制时间(8.04±1.97)d明显快于对照组患者(13.65±2.71)d,差异有统计学意义(t=-8.782,P<0.01);早期组肺部感染患者的感染控制率(88.0%)明显高于对照组患者(58.8%),差异有统计学意义(χ^2=5.979,P<0.05);早期组肺部感染患者的病死率(16.0%)明显低于对照组患者(47.1%),差异有统计学意义(χ^2=6.202,P<0.05);早期组患者的血清HMGB-1水平(65.08±6.29)mmol/L均显著低于对照组患者(71.54±5.80)mmol/L,差异有统计学意义(t=-4.077,P<0.01);早期组患者的血清esRAGE水平(61.51±3.78)mmol/L均显著低于对照组患者(65.62±4.56)mmol/L,差异有统计学意义(t=-3.673,P<0.01)。结论在患者入院后24h内进行气管切开能够明显控制患者肺部感染的发生率,同时能够提高肺部感染的控制率,减少肺部感染患者的病死率,显著降低血清HMGB-1、esRAGE水平。

Objective To investigate the effect of early tracheotomy on pulmonary infection and serum levels of high mobility group protein-1(HMGB-1)and endocrine advanced glycation end product receptor(esRAGE)in patients with severe craniocerebral injury.Methods A total of 80 patients with severe craniocerebral injury were randomly divided into the early group and the control group.Both groups received the same basic treatment.The early group received tracheotomy within 24 hours after admission.The control group received tracheotomy 24 hours after admission.The incidence of pulmonary infection was compared between the two groups.The infection control rate,fatality rate,infection control time,serum HMGB-1 and esRAGE levels before and after tracheotomy were compared between the two groups.Results The incidence of pulmonary infection in the early group(62.5%)was lower than that in the control group(85.0%),the difference was statisticlly significant(χ^2=5.230,P<0.05);the control time of pulmonary infection in the early group(8.04±1.97)d was significantly faster than that in the control group(13.65±2.71)d,the difference was statisticlly significant(t=8.782,P<0.01);the control rate of pulmonary infection in the early group(88.0%)was significantly higher than that in the control group(58.8%),the difference was statisticlly significant(χ^2=5.979,P<0.05);the mortality rate of patients with pulmonary infection(16.0%)was significantly lower than that of the control group(47.1%),the difference was statisticlly significant(χ^2=6.202,P<0.05);the serum HMGB-1 level(65.08±6.29)mmol/L of the early group was significantly lower than that of the control group(71.54±5.80)mmol/L,the difference was statisticlly significant(t=-4.077,P<0.01);the serum esRAGE level of the early group(61.51±3.78)mmol/L was significantly lower than that of the control group(65.62±4.56)mmol/L,the difference was statisticlly significant(t=-3.673,P<0.01).Conclusion Tracheotomy within 24 hours after admission can significantly control the incidence of pulmonary infection,improve the control rate of pulmonary infection,reduce the mortality of patients with pulmonary infection,and significantly reduce the levels of serum HMGB-1 and esRAGE.