CAJ | 학술논문

目的：探讨早期气管切开对严重颅脑疾病患者预后的影响。方法回顾性分析68例严重颅脑疾病患者的临床资料，根据气管切开时间分为两组，入重症医学科（ICU）72 h内给予气管切开的34例为早期气管切开组（ ET组），入ICU 14 d以后给予气管切开的34例为晚期气管切开组（ LT组），比较两组患者的机械通气时间、住院时间、呼吸机相关性肺炎（ VAP）发生率、镇静药物使用时间、抗生素使用时间、住院期间病死率。结果 ET组住院时间、机械通气时间、VAP发生率、镇静药物使用时间、抗生素使用时间分别为（4.2±2．4）d、（3．5±0．6） d、（14．5±3．2）％、（1．5±0．5） d、（3．3±0．3） d，LT组分别为（12．5±4．8） d、（8．5±5．6）d、（28．6±8．6）％、（6．3±1．2）d、（13．2±1．1）d，两组差异均有统计学意义（t＝3．14、2．96、3．28、3．46、2．57，均P＜0．05）；ET组、LT组住院期间病死率分别为（23．8±4．38）％、（24．5±4．16）％，两组差异无统计学意义（t＝1．49，P＞0．05）。结论早期气管切开能够减少严重颅脑疾病患者的住院时间，缩短机械通气时间，降低VAP发生率，减少镇静药物及抗生素的使用时间，但是对患者病死率无影响。
목적：탐토조기기관절개대엄중로뇌질병환자예후적영향。방법회고성분석68례엄중로뇌질병환자적림상자료，근거기관절개시간분위량조，입중증의학과（ICU）72 h내급여기관절개적34례위조기기관절개조（ ET조），입ICU 14 d이후급여기관절개적34례위만기기관절개조（ LT조），비교량조환자적궤계통기시간、주원시간、호흡궤상관성폐염（ VAP）발생솔、진정약물사용시간、항생소사용시간、주원기간병사솔。결과 ET조주원시간、궤계통기시간、VAP발생솔、진정약물사용시간、항생소사용시간분별위（4.2±2．4）d、（3．5±0．6） d、（14．5±3．2）％、（1．5±0．5） d、（3．3±0．3） d，LT조분별위（12．5±4．8） d、（8．5±5．6）d、（28．6±8．6）％、（6．3±1．2）d、（13．2±1．1）d，량조차이균유통계학의의（t＝3．14、2．96、3．28、3．46、2．57，균P＜0．05）；ET조、LT조주원기간병사솔분별위（23．8±4．38）％、（24．5±4．16）％，량조차이무통계학의의（t＝1．49，P＞0．05）。결론조기기관절개능구감소엄중로뇌질병환자적주원시간，축단궤계통기시간，강저VAP발생솔，감소진정약물급항생소적사용시간，단시대환자병사솔무영향。
Objective To investigate the effects of early tracheotomy on the prognosis of patients with severe brain lesions .Methods The clinical data of 68 patients with severe brain lesions were retrospectively analyzed . According to the time of tracheotomy ,we assigned 68 patients to receive either early tracheotomy or late tracheotomy . 34 patients who were given tracheotomy within 72 hours in Intensive Care Unit were selected as the early tracheotomy group (ET group).34 patients who were given tracheotomy after 14 days in Intensive Care Unit were selected as the late tracheotomy group(LT group).The time of mechanical ventilation,length of hospital stay,and the incidence of ventilator associated pneumonia ( VAP ) , sedative drug use time , antibiotic use time , in-hospital mortality were compared between the two groups.Results In ET group,the hospitalization time,mechanical ventilation time, incidence of VAP,sedative drug use time,antibiotic use time were (4.2 ±2.4)d,(3.5 ±0.6)d,(14.5 ±3.2)%, (1.5 ±0.5)d,(3.3 ±0.3)d,those in LT group were (12.5 ±4.8)d,(8.5 ±5.6)d,(28.6 ±8.6)%,(6.3 ±1.2)d, (13.2 ±1.1) d respectively,the differences between the two groups were statistically significant ( t =3.14,2.96, 3.28,3.46,2.57,all P<0.05).The hospitalization mortality rates of ET group ,LT group were (23.8 ±4.38)%, (24.5 ±4.16)%,respectively no significant difference between the two groups ( t=1.49,P<0.05).Conclusion The use of early tracheotomy can reduce the hospitalization time ,shorten the time of mechanical ventilation ,reduce the incidence of ventilator associated pneumonia ,and reduce the time of using sedative drugs and antibiotics ,but the mor-tality has no significant effect in the severe craniocerebral injury patients .