早期气管切开对防治重型颅脑损伤术后肺部感染的作用
早期气管切开对防治重型颅脑损伤术后肺部感染的作用
【摘 要】 目的 探讨早期气管切开对防治重型颅脑损伤术后肺部感染的作用。方法 将92例重型颅脑损伤患者(GCS 3,8分)随机分为观察组(n=46,于伤后?48 h行气管切开)和对照组(n=46,于伤后,48 h行气管切开),两组其余治疗方法相同。结果 观察组肺部感染发生率(45.7%)明显低于对照组(69.6%),P,
0.05;观察组肺部感染控制率(66.7%)明显高于对照组(34.4%),P,0.05,其控制感染时间(10.2?2.16)d短于对照组(12.7?3.43)d,P,0.05。结论 早期气管切开能有效防治重型颅脑损伤术后肺部感染。
【关键词】 气管切开术;重型颅脑损伤;手术;肺部感染
【Abstract】 Objective To investigate effects of early tracheotomy on the treatment and prevention of pulmonary infection for patients with severe craniocerebral trauma. Methods Patients with severe craniocerebral trauma (n=92) were randomly divided into treatment group and control group (46 per group). In treatment group, tracheotomy was performed in 48 hours before injury.In control group, tracheotomy was performed in 48 hours after injury. Results The incidence rate of pulmonary infection in treatment group (45.7%) was significantly lower than that in control (69.6%) (P,0.05).Cured rate of pulmonary infection in treatment group was higher than that in control (P,0.05). The
pulmonary infection in treatment group was significantly shorter than that cured time of
in control (P,0.05). Conclusion Early tracheotomy can effectively prevent and treat pulmonary infection in patients with severe craniocerebral trauma. 【Key words】 Tracheotomy; Severe craniocerebral trauma; Operation; Pulmonary infection 重型颅脑损伤的病死率为19%,60%,1,,其初期死亡与颅脑损伤的严重程度有关,后期死亡的主要原因是肺部感染。因此,防治肺部感染对于重型颅脑损伤的治疗和预后显得尤为重要。本文旨在探讨早期气管切开对防治重型颅脑损伤术后肺部感染的作用。
1 资料与方法
1.1 一般资料 2017年8月,2017年9月按入院时格拉斯哥昏迷评分(Glasgow a scale,GCS)标准选择GCS 3,8分并经头颅CT或MRI检查证实的重型颅脑损伤患者92例,其中脑挫裂伤并急性硬膜下血肿47例,脑挫裂伤并颅内血肿28例,硬膜下血肿并颅底骨折17例;男63例,女29例;年龄21,62岁,平均38.3岁。入院时GCS 3,5分40例,6,8分52例。均开颅行血肿和(或)坏死脑组织清除、去骨瓣减压术,术后住ICU监护治疗。将92例患者随机分为观察组(46例),于伤后?48 h内行气管切开;对照组(46例),于伤后,48 h行气管切开,其他治疗措施如脱水降颅压、激素、抗生素和神经营养药物应用等均与观察组相同。两组患者的性别、年龄、GCS、颅脑损伤类型和手术方式等均具有可比性(P,0.05)。肺部感染的诊断标准按照中华人民共和国卫生部制订的医院感染诊断标准,2,。
1.2 肺部感染的控制标准,3,
?呼吸道分泌物明显减少且体温,38?;
?白细胞总数及分类正常;
?呼吸音清晰。
1.3 统计学处理 计量数据以?s表示,两样本均数比较采用t检验,率的比较用χ2检验,用SPSS 12.0统计软件处理数据。
2 结果 观察组肺部感染21例(45.7%),其中14例得到控制,对照组肺部感染32例(69.6%),其中11例得到控制。观察组肺部感染发生率明显低于对照组,P,0.05;其肺部感染控制率(66.7%)明显高于对照组(34.4%),P,0.05。观察组控制肺部感染的时间(10.2?2.16)d明显短于对照组(12.7?3.43)d,P,0.05。