54例重型颅脑损伤患者行早期气管切开术的

【】 目的：通过对重型颅脑损伤后不同时期气管切开病人的临床疗效和不良反应进行分析,探讨重型颅脑损伤后气管切开的时机选择。方法：选取2009 年 1 月～2014年 1 月期间就诊于我院的108 例重型颅脑损伤行气管切开术的患者,将24 h 内行气管切开术的患者分为早切组,将24 h 后的分为晚切组,两组各54例,比较两组的临床疗效、住院时间及不良反应(肺部感染、低氧血症、皮下气肿)。结果：(1)临床疗效：早切组的治愈率为87.0%,远高于晚切组74.1%,差异具有统计学意义(P<0.05)；早切组的平均机械通气时间为(10.54± 1.21)d,少于晚切组的为(19.71± 2.38)d,差异具有统计学意义(P<0.05)。(2)不良反应：早切组肺部感染率为9.3%,低于晚切组的22.2%；早切组的低氧血症出现率为5.6%,低于晚切组的11.1%；早切组的皮下气肿出现率为9.3%,低于晚切组的18.9%,三者统计比较,差异具有统计学意义(P<0.05)。结论：早切组的临床疗效优于晚切组,不良反应低于晚切组,对于重型颅脑损伤患者的预后,早期行气管切口术,具有非常重要的意义。

The clinical curative effect observation of 54 cases of patients with severe craniocerebral injury by early tracheotomy

Objective: By analyzing the clinical efficacy and adverse reactions of severe craniocerebral injury patients with different periodafter tracheotomy, to investigate the timing of tracheotomy. Methods: from 2009 January to tracheotomy was performed in 108 patients with severe dcraniocerebral patients during 2014 January in our hospital for injured patients, 24 h patients were divided into early tracheotomy within 24 h aftercutting groups, will be divided into late cutting groups, two groups of 54 cases, the clinical effect was compared between the two groups, the time of hospitalization and adverse reactions (pulmonary infection, hypoxemia, subcutaneous emphysema). Results: (1) clinical effect: early group, the cure rate was 87%, far higher than the late cut group 74.1%, withsignificant difference (P<0.05); the mean duration of mechanical ventilation for the early group(10.54 ± 1.21) d, less than the late cutting group was (19.71± 2.38) d, the difference hasstatistical learn the meaning of (P<0.05). (2) adverse reactions: the infection rate of earlypulmonary was 9.3%, lower than late cut group 22.2%;hypoxemia early group rate of 5.6%,lower than the late cut group 11.1%; subcutaneous emphysema early group rate of 9.3%,lower than the late cut group 18.9%, the statistical comparison of the three, with statistically significant differences (P<0.05). Conclusion: the clinical curative effect of early group latecutting groups, adverse reaction is lower than the late cutting groups, for the prognosis of patients with severe craniocerebral injury, early tracheotomy has a very important significance.