重型颅脑损伤患者开颅术后气管切开时机的探讨

Timing of Tracheotomy after Craniotomy in Cases with Severe Traumatic Brain Injury

目的探讨重型颅脑创伤患者开颅术后行气管切开的合理时机。方法回顾性分析2016年1月至2019年1月南充市中心医院神经重症监护室(NICU)收治的156例行气管切开的重型颅脑创伤(sTBI)患者,按开颅术后行气管切开时间分为早期切开组(ET组,<3d,n=89)和晚期切开组(LT组,>3d,n=67)。比较两组患者的一般临床特征(年龄、性别、术前GCS评分),肺部感染发生率和好转率,抗生素使用情况(包括联用抗生素和使用时间),气管切开相关并发症,留置气管导管时间,ICU住院时间,总住院时间,住院费用、神经功能改善情况及死亡率。结果ET组在3周内肺部感染好转率、Ⅱ联抗生素使用率、NICU住院时间,机械通气时间、气管套管留置时间和住院费用均优于LT组(P<0.05),ET组的抗生素使用时间、总住院时间均明显短于ETLT组(P<0.01),两组患者的一般临床特征、格拉斯哥昏迷评分(GCS)、肺部感染发病率、气管切开相关并发症、格拉斯哥预后评分(GOS)及30天内死亡率均无明显差异(P>0.05)。结论重型颅脑损伤患者早期气管切开不能明显改善肺部感染发病率、死亡率和神经功能预后,但对控制肺部感染,减少抗生素使用,减少机械通气和留置气管导管时间,缩短NICU住院时间、总住院时间以及降低住院费用方面具有一定的优势。

ObjectiveTo explore the appropriate timing of tracheotomy after craniotomy in cases with severe traumatic brain injury.MethodsA retrospective analysis was made to the clinical data of 156 cases with severe traumatic brain injury(sTBI)who underwent tracheotomy during the period from January,2016 to January,2019;the cases were divided,based on the timing of tracheotomy after craniotomy,into 2 groups:early tracheotomy group(ET group,given tracheotomy within 3 days after craniotomy,n=89)and late tracheotomy group(LT group,given tracheotomy more than 3 days after craniotomy,n=67);a comparative study between the 2 groups was made to the age,sex,pre-operative Glasgow Coma Scale(GCS)scores,occurrence of pulmonary infection,improvement rate,application of antibiotics(combined application and the time length of application),occurrence of complications related to tracheotomy,the indwelling time of endotracheal tube,days in ICU and the total time length of hospitalization,hospitalization expense,the improvement of neural function and mortality rate.ResultsAfter treatment,the improvement rate of pulmonary infection within 3 weeks,bi-application of antibiotics,days in NICU,time length of mechanical ventilation,the indwelling time of endotracheal tube and hospitalization expense in ET group were all superior to those in LT group(P<0.05);the time length of antibiotic application and the total days of hospitalization in ET group were both shorter than those in LT group(P<0.01);there existed no statistical differfences in sex,age,GCS score,pulmonary infection occurrence,post-tracheotomy complications,Glasgow Outcome Score(GOS)and 30-day mortality between the 2 groups(all P>0.05).ConclusionsEarly tracheotomy in cases with sTBI can not obviously improve the occurrence of pulmonary infection,mortality and the prognosis of neural function while it is of certain effect in controlling pulmonary infection,decreasing the application of antibiotics,cutting down the time of mechanical ventilation and endotracheal tube indwelling,shortening the time in NICU and the total hospitalization time and saving the hospitalization expense.