气管切开术与插管术在重症脑外伤中应用的比较

目的比较气管切开术与插管术在重症脑外伤患者治疗中,住院时间、应用呼吸机辅助呼吸时间、术后肺炎发病率及病死率的差异。方法回顾性分析2000-05~2006-11我院住院治疗的符合以下标准的脑外伤患者:单纯脑外伤,在伤后第1d及第3d Glasgow昏迷评分(GCS)≤8,CT显示脑损伤。随机分为气管切开组(n=27)及气管插管组(n=31),比较2组患者住院时间、应用呼吸机时间、术后肺炎发病率及病死率的差异。结果气管切开组应用呼吸机时间平均为(9±4.6)d,气管插管组平均为(13±3.6)d,2组间有显著差异。而总住院时间、术后肺炎发病率及病死率2组间均无明显差异。结论气管切开术可以明显减少应用呼吸机辅助呼吸时间,但在减少患者住院时间、术后肺炎发病率及病死率方面无明显差异,表明脑外伤昏迷患者早期进行气管切开术有利于患者自主呼吸功能的恢复。

Comparison of tracheostomy and endotracheal intubation in severe head injury

Objective To investigate the difference of tracheostomy in reducing the duration of mechanical ventilation,ICU stay,incidence of pneumonia and mortality comparisd with intubation in patients with head injury.Methods The patients with severe head injury from May,2000 to December,2005 in our department were retrospectively reviewed who met the following criteria: isolated head injury,Glasgow coma scale(GCS) score <8(first day),with cerebral contusion on CT scan.On the second day,randomization was done in two groups: tracheostomy group(n= 27) and endotracheal intubation group(n= 31).Total time of mechanical ventilation,ICU stay,pneumonia incidence and mortality of these patients were evaluated.Results The mean time of mechanical ventilatory support was shorter in tracheostomy group than that in endotracheal intubation group(P<0.05).There was a significant difference in duration of mechanical ventilation between two groups,while there was no difference in frequency of pneumonia or mortality between the two groups.Conclusion In severe head injury,tracheostomy can decrease ventilation time.Early tracheostomy would be helpful to the recovery of lung function.