早期气管切开对重型颅脑损伤患者的临床疗效分析

Clinical therapeutic effects of early tracheotomy in patients with severe traumatic brain injury

目的探讨早期气管切开对重型颅脑损伤患者的临床疗效。方法回顾性分析2018年5月至2019年11月福建省立医院重症医学三科收治的76例重型颅脑损伤患者,依据气管切开的时机不同分为两组:观察组(早期气管切开,n=38)和对照组(晚期气管切开,n=38),分别比较两组患者的肺部感染及控制情况,以及消化道出血、急性肾损伤、电解质紊乱等并发症的发生率,并比较两组患者的机械通气时间、ICU住院时间、总住院时间、30d死亡率等指标。结果观察组较对照组肺部感染率显著下降,感染控制率显著提高,感染控制时间显著缩短,差异有统计学意义(P<0.05);两组患者消化道出血、急性肾损伤、电解质紊乱的发生率差异无统计学意义(P>0.05);观察组机械通气时间、ICU住院时间、总住院时间均少于对照组,差异有统计学意义(P<0.05),但两组患者30d死亡率比较差异无统计学意义(P>0.05)。结论早期气管切开有可能减少重型颅脑损伤患者肺部感染的发生,促进感染的控制,缩短机械通气时间及住院时间,值得在临床中推广应用。

Objective To investigate the clinical therapeutic effects of early tracheotomy in patients with severe traumatic brain injury.Methods A retrospective analysis was performed at the Third Department of Critical Care Medicine in Fujian Provincial Hospital from May 2018 to November 2018.Seventy-six patients with severe traumatic brain injury were included.They were divided into observation group(early tracheotomy,n=38)and control group(late tracheotomy,n=38)according to the timing of tracheotomy.The pulmonary infection rate,control rate,control period,and the incidences of gastrointestinal hemorrhage,acute kidney injury and electrolyte disorder were compared.The duration of mechanical ventilation,length of stay in ICU,total length of stay in hospital and mortality rate within 30 days were also compared.Results The rate of pulmonary infection was significant lower in observation group than that in control group(P<0.05).The rate of pulmonary control was significant higher in observation group than that in control group(P<0.05).The control period was significant shorter in observation group than that in control group(P<0.05).There was no significant difference in the incidences of gastrointestinal hemorrhage,acute kidney injury and electrolyte disorder between the two groups(P>0.05).The duration of mechanical ventilation,length of stay in ICU,total length of stay in hospital were shorter in observation group than those in control group(P<0.05),but there was no significant difference in mortality rate within 30 days between the two groups(P>0.05).Conclusion Early tracheotomy could reduce the rate of pulmonary infection,promote the control of pulmonary infection,shorten the duration of mechanical ventilation and length of stay in hospital.It is worth being applied to clinical practice.