CAJ | 학술논문

目的：探讨不同时期行气管切开手术对重度颅脑损伤患者肺部感染的影响。方法95例行气管切开的重度颅脑损伤患者依据气管切开的时间不同分为早期气管切开组(早期组)43例和晚期气管切开组(晚期组)52例，比较两组患者在颅脑损伤后7、28 d时肺部感染评分(CPIS)的变化，以及两组中CPIS评分≥6分患者所占的比例。结果早期气管切开组患者在颅脑损伤后7 d时CPIS(5.67±0.99)分低于晚期气管切开组(6.23±0.68)分，同时CPIS评分≥6分患者所占的比例早期气管切开组也低于晚期气管切开组，差异均有统计学意义(P<0.05)；而颅脑损伤后28 d时，两组CPIS差异无统计学意义(P>0.05)，但CPIS评分≥6分患者所占的比例，早期气管切开组仍低于晚期气管切开组，差异有统计学意义(P<0.05)。结论重度颅脑损伤患者48 h内行气管切开手术治疗有利于肺部感染控制，减轻肺部感染的严重程度，因此对于有指征的重度颅脑损伤患者建议早期行气管切开治疗。
목적：탐토불동시기행기관절개수술대중도로뇌손상환자폐부감염적영향。방법95례행기관절개적중도로뇌손상환자의거기관절개적시간불동분위조기기관절개조(조기조)43례화만기기관절개조(만기조)52례，비교량조환자재로뇌손상후7、28 d시폐부감염평분(CPIS)적변화，이급량조중CPIS평분≥6분환자소점적비례。결과조기기관절개조환자재로뇌손상후7 d시CPIS(5.67±0.99)분저우만기기관절개조(6.23±0.68)분，동시CPIS평분≥6분환자소점적비례조기기관절개조야저우만기기관절개조，차이균유통계학의의(P<0.05)；이로뇌손상후28 d시，량조CPIS차이무통계학의의(P>0.05)，단CPIS평분≥6분환자소점적비례，조기기관절개조잉저우만기기관절개조，차이유통계학의의(P<0.05)。결론중도로뇌손상환자48 h내행기관절개수술치료유리우폐부감염공제，감경폐부감염적엄중정도，인차대우유지정적중도로뇌손상환자건의조기행기관절개치료。
Objective To discuss the influence tracheotomy in different time periods on the pulmonary infection of patients with severe craniocerebral injury.Methods By different time of tracheotomy, a total of 95 patients with severe craniocerebral injury were divided into early tracheotomy group (early group) with 43 cases and late tracheotomy group (late group) with 52 cases. The changes of clinical pulmonary infection score (CPIS) and proportion of CPIS≥6 after 7 d and 28 d of craniocerebral injury were compared between the two groups. Results The CPIS score of the early tracheotomy group after 7 d of craniocerebral injury was (5.67±0.99) points, which was lower than (6.23±0.68) points of the late tracheotomy group. The proportion of patients with CPIS≥6 in the early tracheotomy group was also lower than the late tracheotomy group. The differences had statistical significance (P<0.05). After 28 d of craniocerebral injury, there was no statistically significant difference of CPIS between the two groups (P>0.05). The proportion of patients with CPIS≥6 in the early tracheotomy group was still lower than the late tracheotomy group, and the difference had statistical significance (P<0.05). Conclusion Tracheotomy applied within 48 h for severe craniocerebral injury patients is good for pulmonary infection control and severity relief. Therefore, early tracheotomy is recommended for severe craniocerebral injury patients with obvious indication.