气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响

目的研究气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响。方法回顾2011-04—2015-04我院收治的大量高血压脑出血患者80例,按照气管切开的时机分为早期气管切开组35例,晚期气管切开组45例。对于早期气管切开组患者,急诊手术同时行气管切开。患者进入手术室行术前准备后,由手术医师快速行经皮微创气管切开术(PDT)。晚期气管切开组根据病情于术后2~14d内行气管切开术,操作同上。结果 35例早期气管切开组患者好转32例(91.4%),死亡3例(8.6%);45例晚期气管切开组好转出院35例(77.8%),死亡10例(22.2%);早期气管切开组肺部感染23例(65.7%),晚期气管切开组肺部感染45例(100%)。早期气管切开组肺部感染率明显低于晚期气管切开组,差异有统计学意义(P0.05);早期气管切开组术后2个月日常生活能力(ADL)Ⅱ~Ⅲ级25例(71.4%),ADLⅣ级7例(20%)。晚期组术后2个月ADLⅡ~Ⅲ级20例(44.4%),ADLⅣ级15例(33.3%)。术后2个月后早期组日常生活能力明显高于晚期组;早期气管切开组平均住院时间(34.13±6.51)d,晚期气管切开组为(43.45±10.72)d,早期组平均住院时间少于晚期组,早期组再出血2例(5.71%),晚期组再出血5例(11.11%),差异有统计学意义(P0.05)。结论早期气管切开可有效提高患者的好转出院率,减轻肺部感染,提高日常生活能力,且可以缩短住院时间,降低再出血风险。

The influence of the timing of tracheotomy on the survival of patients with massive hypertensive intracerebral hemorrhage

Objective To study the influence of the timing of tracheotomy on the survival of patients with hypertensive intracerebral hemorrhage .Methods Eighty cases of hypertensive cerebral hemorrhage in our hospital were selected from April 2011 to April 2015 ,and according to the timing of tracheotomy were divided into early tracheotomy group of 35 cases and late tracheotomy group of 45 cases .For the patients of early tracheotomy group ,tracheotomy was performed at the same time .Pa‐tients entered the operation room preoperative preparation ;the surgeon quickly took rapid percutaneous dilational tracheostomy (PDT) .For the patients in late tracheotomy group ,PDT was given according to patients’ condition after 2-14 days after emer‐gency operation .Results Of 35 patients of early tracheotomy group ,32 cases were improved and discharged ,the proportion was 91.4% ;death in 3 cases ,the proportion of 8.6% .Of 45 patients of late tracheotomy group ,35 cases were improved and discharged ,the proportion was 77.8% ;death in 10 cases ,the proportion was 22.2% .Early tracheal incision group had pulmo‐nary infection in 23 cases (65.7% )and late stage tracheal incision group was 45 cases(100% ) .Pulmonary infection rate in early tracheotomy group was significantly lower than that of the late tracheotomy group ,the difference was statistically significant (P<0.05);In the early tracheotomy group ,the daily life ability(ADL)Ⅱ-Ⅲ after 2 months in 25 cases ,accounted for 71.4% , ADL Ⅳ in 7 cases ,accounting for 20% .In the late postoperative ,ADL Ⅱ-Ⅲ in 20 cases ,accounting for 44.4% ,ADL Ⅳ in 15 cases ,accounting for 33.3% .The early tracheotomy group patients’ ADL was significantly higher than the late tracheotomy group .The average hospitalization time in early tracheotomy group was (34.13 ± 6.51)days ,which was(43.45 ± 10.72)days in late tracheotomy group ,the early tracheotomy group was less than the late tracheotomy group .In early tracheotomy group ,re‐bleeding in 2 cases ,accounted for 5.71% ,which was 5 cases in late tracheotomy group ,accounted for 11.11% ,the difference is statistically significant(P<0.05) .Conclusion Early tracheotomy can effectively improve the discharge rate ,alleviate pulmona‐ry infection ,improve the patients'activities of daily living ,and reduce the hospitalization time and the risk of rebleeding .