早期气管切开对中重度脑损伤机械通气患者的临床意义

The clinical significance of early tracheotomy on mechanically ventilated patients with moderate and severe brain injury

目的探讨中重度脑损伤机械通气患者气管切开最佳时机。方法采用病例对照研究方法,选取2020年4月至2022年3月在湖南省人民医院收治的中重度脑损伤患者为研究对象,按照气管切开距气管插管时间≤3d为早期气管切开组,>3d为晚期气管切开组。比较两组患者的一般资料、机械通气时间、呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率、重症监护病房(intensive care unit,ICU)住院时间、ICU死亡率、格拉斯哥预后GOS(glasgow outcome scale,GOS)评分、医院住院费用。结果最终纳入175例患者,其中早期气管切开组67例,晚期气管切开组108例。早期气管切开组与晚期气管切开组相比,早期气管切开组机械通气天数短(5.9±6.6vs.11.7±8.7,P<0.001)、VAP发生率低(20.9%vs.44.4%,P=0.002)、ICU住院天数短(13.8±10.5vs.17.6±11.4,P=0.029)、住院费用低(132274.0(97170.5,189076.0元))vs.164647.0(132849.2,224530.5元,P=0.003)、ICU病死率高(14.9%vs.5.6%,P=0.0037)。结论早期气管切开能够降低中重度脑损伤机械通气患者的VAP发生率,缩短机械通气时间及ICU住院时间,并减轻住院费用,但并未降低ICU病死率。

Objective To explore the optimal timing of tracheostomy in mechanically ventilated patients with moderate to severe traumatic brain injury.Methods A case-control study method was used,selecting patients with moderate to severe traumatic brain injury admitted to Hunan Provincial People's Hospital from April 2020 to March 2022 as the research subjects.According to the time from endotracheal intubation to tracheostomy,patients were divided into an early tracheostomy group(≤3 days)and a late tracheostomy group(>3 days).The general data,duration of mechanical ventilation,incidence of ventilator-associated pneumonia(VAP),length of stay in the intensive care unit(ICU),ICU mortality rate,Glasgow Outcome Scale(GOS)score,and hospitalization costs of the two groups were compared.Results A total of 175 patients were included,with 67 in the early tracheostomy group and 108 in the late tracheostomy group.Compared with the late tracheostomy group,the early tracheostomy group had a shorter duration of mechanical ventilation(5.9±6.6vs.11.7±8.7,P<0.001),a lower incidence of VAP(20.9%vs.44.4%,P=0.002),a shorter ICU length of stay(13.8±10.5vs.17.6±11.4,P=0.029),lower hospitalization costs(132274.0(97170.5,189076.0 yuan)vs.164647.0(132849.2,224530.5 yuan),P=0.003),and higher ICU mortality rate(14.9%vs.5.6%,P=0.0037).Conclusions Early tracheostomy can reduce the incidence of VAP in mechanically ventilated patients with moderate to severe traumatic brain injury,shorten the duration of mechanical ventilation and ICU length of stay,and reduce hospitalization costs,but does not reduce the ICU mortality rate.