不同时期行气管造口术对脑损伤患者的影响

Effect of early tracheostomy versus late tracheostomy on treatment outcomes and prognosis for traumatic brain injury patients

目的比较早期与后期气管造口术对外伤性脑损伤患者结局及预后的不同影响。方法76例外伤性脑损伤患者(Glasgow昏迷等级≤8)作为研究对象,入院六天内做过气管造口术的患者认为进行早期气管造口术,为ET组;而第六天之后做气管造口术的患者认为进行晚期气管造口术,为LT组。对两组患者进行住院时间、重症监控时间、死亡率、呼吸机相关肺炎发病率及出院6个月预后进行评估对比。结果ET组患者有较短的住院时间(38.5vs.46.4天;P=0.038)及重症监护时间(26.7vs.34.8天;P=0.008)。两组患者的死亡率差异并没有显著性(P>0.99)。尽管没有统计显著性,Glasgow昏迷等级>4的ET组患者有较好的结局及预后(P=0.335),而且呼吸机相关肺炎发病率较低(P=0.481)。多变量分析显示ET组患者(Glasgow昏迷等级>4分)6个月预后得到显著改善(OR=2.524;95%置信区间:1.029~6.236)。患者年龄与较好的结局之间为负相关(OR=1.947;CI:0.936~2.981)。结论外伤性脑损伤患者入院后6天内进行气管造口术有较短的住院及重症监护时间,以及能够帮助改善患者治疗结局及预后。

Objective To compare the effect of early tracheostomy(ET)versus late tracheostomy(LT)on traumatic brain injury(TBI)-related outcomes and prognosis.Methods This study was consisted of 152 TBI patients with a Glasgow Coma Scale(GCS)score≤8.Patients who had tracheostomy before or at the sixth day of their admission were considered as ET,and those who had tracheostomy after the sixth day of admission were considered as LT.The effect of ET and LT on hospital and ICU stay,mortality,VAP rate,and GCS on discharge were evaluated.Furthermore,Glasgow Outcome Scale(GOS)was assessed on discharge and at 6 months after discharge.Results Patients with ET had a significantly shorter hospital stay(38.5 vs 46.4 days;P=0.038)and intensive care unit stay(26.7 vs 34.8 days;P=0.008).There was no significant difference in mortality between the two groups(P>0.99).Although without statistical significance,those patients with Glasgow Outcome Scale>4 in the ET group had better outcomes and prognosis and lower incidence of ventilation-associated pneumonia(P=0.335 and P=481,respectively).Multivariate analysis showed that ET significantly improved 6-month prognosis(Glasgow Outcome Scale>4)(odds ratio=2.524;95%confidence interval:1.029~6.236).Older age was inversely associated with favorable prognosis(odds ratio=1.947;confidence interval:0.936~2.981).Conclusion Tracheostomy for patients with severe TBI 6 days after their hospital admission can also decrease hospital and intensive care unit stay,and improve their prognosis.