中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2012年
7期
597-601
,共5页
张庚%胡马洪%陈扬波%金心%王定坤
張庚%鬍馬洪%陳颺波%金心%王定坤
장경%호마홍%진양파%금심%왕정곤
脑损伤%气管切开术%呼吸,人工
腦損傷%氣管切開術%呼吸,人工
뇌손상%기관절개술%호흡,인공
Brain injuries%Tracheotomy%Respiration,artificial
目的 评价早期气管切开(early tracheostomy,ET)与晚期气管切开(late tracheostomy,LT)对重型脑外伤的影响.方法 回顾性分析2001年5月-2010年12月采用经皮扩张气管切开术(percutaneous dilational tracheostomy,PDT)行气管切开需长时间机械通气、GCS＜9分的重型脑外伤患者167例.依据口插管机械通气时间≤7d为ET组81例,＞7d为LT组86例,比较两组患者的临床基础特征、PDT前后机械通气时间、总机械通气时间、PDT后住ICU时间、ICU住院时间和住院时间以及死亡率.结果 两组在年龄、性别、急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分、GCS评分、创伤指数和开颅手术率差异均无统计学意义(P＞0.05).ET组显著缩短了PDT前机械通气时间[(5.16±1.33)d∶(11.64±4.25)d,P＜0.01)]、PDT后机械通气时间(中位数15.0d∶17.0d,P＜0.05)、总机械通气时间(中位数18.0d∶26.0d,P＜0.05)以及PDT后住ICU时间(中位数16.0d∶21.0d,P＜0.01)和ICU住院时间(中位数21.0d∶32.0d,P＜0.01),两组住院时间差异无统计学意义(P＞0.05).两组ICU死亡率(17％∶14％,P＞0.05)和住院死亡率(25％∶28.4％,P＞0.05)差异均无统计学意义.Kaplan-Meier曲线显示ET组60d患者机械通气使用率和ICU住院率较LT组显著降低.结论 重型脑外伤患者行早期气管切开可缩短机械通气时间和ICU住院时间,但不影响患者的预后.对重型脑外伤患者可行早期气管切开.
目的 評價早期氣管切開(early tracheostomy,ET)與晚期氣管切開(late tracheostomy,LT)對重型腦外傷的影響.方法 迴顧性分析2001年5月-2010年12月採用經皮擴張氣管切開術(percutaneous dilational tracheostomy,PDT)行氣管切開需長時間機械通氣、GCS＜9分的重型腦外傷患者167例.依據口插管機械通氣時間≤7d為ET組81例,＞7d為LT組86例,比較兩組患者的臨床基礎特徵、PDT前後機械通氣時間、總機械通氣時間、PDT後住ICU時間、ICU住院時間和住院時間以及死亡率.結果 兩組在年齡、性彆、急性生理和慢性健康狀況評估Ⅱ(APACHEⅡ)評分、GCS評分、創傷指數和開顱手術率差異均無統計學意義(P＞0.05).ET組顯著縮短瞭PDT前機械通氣時間[(5.16±1.33)d∶(11.64±4.25)d,P＜0.01)]、PDT後機械通氣時間(中位數15.0d∶17.0d,P＜0.05)、總機械通氣時間(中位數18.0d∶26.0d,P＜0.05)以及PDT後住ICU時間(中位數16.0d∶21.0d,P＜0.01)和ICU住院時間(中位數21.0d∶32.0d,P＜0.01),兩組住院時間差異無統計學意義(P＞0.05).兩組ICU死亡率(17％∶14％,P＞0.05)和住院死亡率(25％∶28.4％,P＞0.05)差異均無統計學意義.Kaplan-Meier麯線顯示ET組60d患者機械通氣使用率和ICU住院率較LT組顯著降低.結論 重型腦外傷患者行早期氣管切開可縮短機械通氣時間和ICU住院時間,但不影響患者的預後.對重型腦外傷患者可行早期氣管切開.
목적 평개조기기관절개(early tracheostomy,ET)여만기기관절개(late tracheostomy,LT)대중형뇌외상적영향.방법 회고성분석2001년5월-2010년12월채용경피확장기관절개술(percutaneous dilational tracheostomy,PDT)행기관절개수장시간궤계통기、GCS＜9분적중형뇌외상환자167례.의거구삽관궤계통기시간≤7d위ET조81례,＞7d위LT조86례,비교량조환자적림상기출특정、PDT전후궤계통기시간、총궤계통기시간、PDT후주ICU시간、ICU주원시간화주원시간이급사망솔.결과 량조재년령、성별、급성생리화만성건강상황평고Ⅱ(APACHEⅡ)평분、GCS평분、창상지수화개로수술솔차이균무통계학의의(P＞0.05).ET조현저축단료PDT전궤계통기시간[(5.16±1.33)d∶(11.64±4.25)d,P＜0.01)]、PDT후궤계통기시간(중위수15.0d∶17.0d,P＜0.05)、총궤계통기시간(중위수18.0d∶26.0d,P＜0.05)이급PDT후주ICU시간(중위수16.0d∶21.0d,P＜0.01)화ICU주원시간(중위수21.0d∶32.0d,P＜0.01),량조주원시간차이무통계학의의(P＞0.05).량조ICU사망솔(17％∶14％,P＞0.05)화주원사망솔(25％∶28.4％,P＞0.05)차이균무통계학의의.Kaplan-Meier곡선현시ET조60d환자궤계통기사용솔화ICU주원솔교LT조현저강저.결론 중형뇌외상환자행조기기관절개가축단궤계통기시간화ICU주원시간,단불영향환자적예후.대중형뇌외상환자가행조기기관절개.
Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.
