早期与延迟PCT术对重型颅脑损伤患者预后影响的对比观察

目的比较早期与延迟经皮扩张气管切开术(PCT)对重型颅脑损伤患者的影响。方法 252例行PCT的重型颅脑损伤患者,根据气管切开时机分早期气管切开术(早期PCT组,n=122)和延迟气管切开术(延迟PCT组,n=130)两组,观察两组患者一般情况,行气管切开术当天进行急性生理功能和慢性健康状况评分系统(APACHE)Ⅱ和格拉斯哥昏迷评分(GCS),ICU留滞时间,28 d ICU病死率,在院病死率等;同时观察两组患者肺部感染情况、致病菌类型、机械通气天数等。结果早期PCT组的ICU留滞时间和机械通气的时间明显短于延迟PCT组,P均<0.01,但两组的28 d ICU病死率及总病死率差异无统计学意义(P>0.05)。同时,两组患者肺部感染发生率差异无统计学意义(P>0.05),且两组患者细菌性肺炎的发生率也相近(P>0.05),但延迟PCT组肺部真菌感染却明显多于早期PCT组(P<0.05)。结论早期气管切开对重型颅脑损伤患者的病死和肺部感染率无明显影响,但可缩短患者ICU留滞时间和机械通气时间,并可降低真菌感染的发生率。

Study on the influence of early percutaneous tracheostomy on prognosis of patients with severe craniocerebral injury

Objective To compare the effect of timing percutaneous tracheostomy （PCT） on outcome of patients with severe craniocerebral injury. Methods A total of 252 patients with severe craniocerebral injury were divided into early PCT group （ n = 122 ） and delayed PCT group （ n = 130） according to the timing for operation. The general data of patients, APACHE Ⅱscores and Glasgow coma scores, days of ICU stay, mortality of 28 days in ICU and hospital were recorded. Meanwhile, pneumonia, types of pathogens and length of ventilator support were recorded. Results Days of ICU stay or length of ventilator support in early PCT group were significantly shorter than those of delayed PCT group, and they were 19.6 ± 6.6 days vs. 23.8 ± 7.4 days and 16.8 ± 6.2 days vs. 21.0 ± 7.1 days respectively, the difference between them was significant （ P 〈 0.01 ）. However, the mortality of 28 days in ICU or in hospital of 2 groups was similar （ P 〉 0.05 ）. Although the incidence of pneumonia was also similar in both groups, and patients in delayed PCT group were suffered with more fungal infections （28.69% vs. 50.00%, P 〈 0.05 ）. Conclusion Although early PCT had no significant influence on mortality or incidence of pneumonia in patients with severe craniocerebral injury, and it will decrease the duration of ICU stay and ventilator support, but it also reduce the incidence of fungal infection.