基底节区高血压脑出血术后早期经皮扩张气管切开疗效分析

Efficacy analysis of early percutaneous dilational tracheotomy in postoperative patients with hypertensive basal ganglia hemorrhage

目的分析基底节区高血压脑出血术后早期经皮扩张气管切开的疗效。方法纳入2019年8月—2021年7月蚌埠医学院第一附属医院神经外科收治的108例基底节区高血压脑出血术后行气管切开患者,2d内气管切开为研究组60例和2天后气管切开为对照组48例,分析气管切开后两组患者血氧饱和度、呼吸机脱机时间、肺部感染情况、气管切开前后格拉斯哥昏迷指数(Glasgow Coma Scale,GCS)评分和神经外科重症监护病房(Neurosurgical Itensive Care Unit,NICU)治疗时间。结果气管切开后两组患者血氧饱和度均有所改善,且研究组血氧饱和度(98.57±1.13)%比对照组血氧饱和度(96.25±1.23)%改善程度高,差异均有统计学意义(P<0.001)。应用呼吸机患者,研究组脱离呼吸机时间比对照组更早,差异有统计学意义(P<0.05)。术后肺部感染研究组21例(35.00%),对照组26例(54.17%),肺部感染率研究组更低,且感染控制时间研究组(8.75±1.60)d也少于对照组(13.50±2.21)d,差异均有统计学意义(P<0.05);感染类型在两组肺部感染患者中比较差异无统计学意义(P>0.05)。气管切开后14d两组患者GCS评分均增高,且研究组(10.58±2.12)分比对照组(9.44±1.18)分评分值要高,差异有统计学意义(P<0.001)。患者NICU治疗时间研究组(8.18±2.12)d短于对照组(10.46±2.49)d,差异有统计学意义(P<0.001)。结论早期气管切开能改善基底节区高血压脑出血患者术后血氧饱和度,使其尽早脱机,减少肺部感染率和肺部控制时间,帮助患者神经功能恢复,缩短NICU治疗时间。

Objective To analyze the effect of early percutaneous dilational tracheotomy in postoperative patients with hypertensive basal ganglia hemorrhage.Methods This study collected 108postoperative patients who had hypertensive basal ganglia hemorrhage and underwent postoperative tracheotomy at Neurosurgery Department of The First Affiliated Hospital of Bengbu Medical College from August 2019to July 2021.They were divided into the study group(the timing of tracheotomy≤2days,60cases)and the control group(the timing of tracheotomy>2days,48cases).After tracheotomy,the researchers analyzed the blood oxygen saturation,ventilator offline time,pulmonary infection,Glasgow Coma Scale(GCS)score before and after tracheotomy and the treatment time in Neurosurgical Intensive Case Unit(NICU)in two groups.Results After tracheotomy,blood oxygen saturation was improved in both groups,and the study group had higher degree of improvement(98.57±1.13)%in blood oxygen saturation than the control group(96.25±1.23)%,with statistically significant difference(P<0.001).In patients using ventilator,the time of disconnecting from ventilator in the study group was earlier than that in the control group,and the difference was statistically significant(P<0.05).There were 21cases(35.00%)of postoperative pulmonary infection in the study group and 26cases(54.17%)in the control group.The pulmonary infection rate in the study group was lower,and their infection control time[(8.75±1.60)d]was also lower than that of the control group[(13.50±2.21)d],indicating statistically significant difference(P<0.05).There was no significant difference in pulmonary infection types between infectious cases of two groups(P>0.05).In fourteen days after tracheotomy,the GCS scores in both groups increased,and the score(10.58±2.12)of the study group was higher than that(9.44±1.18)of the control group,with statistically significant difference(P<0.001).The treatment time[(8.18±2.12)d]at NICU for the study group was shorter than that[(10.46±2.49)d]of the control group,and the difference was statistically significant(P<0.001).Conclusion Early tracheotomy can improve postoperative oxygen saturation of patients with hypertensive basal ganglia hemorrhage.It can make them get off ventilator as early as possible,reduce pulmonary infection rate and pulmonary control time,as well as help with recovery of patients’neurological function and shorten their treatment time at NICU.