早期和晚期气管切开术对重型颅脑损伤昏迷患者预后的影响

Effects of early and late tracheotomy on prognosis of patients with coma induced by severe craniocerebral injury

目的:观察并比较重型颅脑损伤昏迷患者行早期和晚期气管切开术的临床结果。方法:收集2020年3月到2023年9月期间赣州市人民医院NICU收治的重型颅脑损伤患者76例的临床资料,根据气管切开的时机分为早期组(n=42)和晚期组(n=34)。记录每位患者NICU住院时长、总住院时长、呼吸机使用时长、抗生素使用率、肺炎发生率、病死率。出院时,使用改良Rankin量表评分(mRS)评估神经功能恢复情况。在伤后6个月,采用格拉斯哥预后评分(GOC)评估预后。结果:早期组NICU住院时长、总住院时长、呼吸机使用时长明显较短,抗生素使用率和肺炎发生率明显较低(P<0.05),病死率间差异不显著(P>0.05)。出院时早期组mRS评分明显较低(P<0.05)。6 m后,早期组恢复良好率明显较高(P<0.05)。结论:重型颅脑损伤昏迷患者实施早期气管切开能改善其预后,减少肺部感染等事件发生率,促进病情更好恢复。

Objective:To observe and compare the clinical effect of early and late tracheotomy in patients with coma induced by severe craniocerebral injury.Methods:The clinical data were collected from 76 patients with severe craniocerebral injury admitted to NICU of Ganzhou People's Hospital between March 2020 and September 2023.According to the timing of tracheotomy,patients were divided into early group(n=42)and late group(n=34).The stay time in NICU,total length of hospital stay,use time of ventilator,use rate of antibiotics,incidence of pneumonia and mortality were recorded.At discharge,recovery of nerve function was evaluated by modified Rankin scale(mRS).At 6 months after injury,prognosis was evaluated by Glasgow outcome scale(GOC).Results:Compared with late group,stay time in NICU,total length of hospital stay and use time of ventilator were significantly shorter,use rate of antibiotics and incidence of pneumonia were significantly lower in early group(P<0.05),but there was no significant difference in mortality between the two groups(P>0.05).At discharge,mRS score in early group was significantly lower than that in late group(P<0.05).6 months later,good rate of recovery in early group was significantly higher than that in late group(P<0.05).Conclusion:Early tracheotomy can improve prognosis,reduce the incidence of lung infection and promote better recovery in patients with coma induced by severe craniocerebral injury.