神经外科术后气管切开术的并发症与手术时机的选择

目的 探讨神经外科术后气管切开术并发症发生率及气管切开时机的选择。方法 回顾性分析2012年8月至2013年8月收治的266例神经外科术后建立人工气道的临床资料。结果 266例中，单纯气管插管209例（18例出院随访数据缺失），其中气管插管时间<7 d 148例，7~14 d 24例，>14 d 19例；行气管切开术57例[3例出院随访数据缺失，余54例中，早期气管切开术（气管插管时间≤7 d）38例，晚期气管切开术（气管插管时间>7 d）16例]。单纯气管插管病人肺部感染发生率及院内病死率均明显低于气管切开术病人（P<0.05），入住ICU时间较气管切开术病人明显缩短（P<0.05）。住院期间，早期与晚期气管切开术病人肺部感染发生率、机械通气时间、入住ICU时间、GCS评分均无统计学差异（P>0.05）；出院后，早期与晚期气管切开术病人严重出血、皮下气肿、气胸、肺部感染、气管狭窄等发生率以及病死率均无统计学差异（P>0.05）。结论 神经外科术后病人是否需要早期气管切开术或晚期气管切开术，需要综合考虑病人情况及利弊得失，做出对病人最有利的决策。

Complications and timing of tracheotomy after neurosurgical operation

Objective To investigate the incidence of complications and timing of tracheotomy in the patients after neurosurgery. Methods A retrospective analysis of 226 patients, who stayed for more than 24 hours in Intensive Care Unit (ICU) after the neurosurgical operation from August, 2012 to August, 2013 was performed. The factors related to the artificial airway were analyzed. Results Of these 266 patients, 209 patients received simple endotracheal intubation and 57 tracheotomy. The incidence of pulmonary infection in the patients with endotracheal intubation was significantly lower than that in the patients with tracheotomy (P<0.05). There were insignificant differences in the average age, duration of ICU stay, GCS scores, the time of mechanical ventilation and the incidence of pneumonia between the patients who underwent early tracheostomy (intubation duration before the tracheotomy ≤7 days, n=38) and the patients late underwent tracheostomy (intubation duration before the tracheotomy >7 days, n=16; P>0.05). Conclusion With the improvement of endotracheal intubation and nursing level, whether the patient need early tracheotomy, even the so-called late tracheotomy after the neurosurgical operation should be comprehensively considered according to the patient’s condition in order to make the best decisions for patient.