大量脑出血手术患者的气管切开时机研究

摘要

Objective To study the best time for tracheotomy for patients with massive cerebral hemorrhage, and the relationships with prognosis.Methods Seventy patients with massive cerebral hemorrhage treated in our hospital between 2014 January and 2016 January were selected in this research. According to the different time for tracheotomy, these patients were divided into 3 groups: the ultra early group, early tracheotomy group and late tracheotomy group. In these groups of patients, the post-operative recurrent bleeding, incidence of tracheal cannula retention time, rate of pulmonary infection, mean hospital stay, mortality in 3 weeks were evaluated.Results There was no significant difference in the rate of recurrent bleeding between the three groups(P>0.05). The retention time and the average hospital stay in ultra early group were significantly shorter than those of the early and late groups, and the case was the same between the early group and the late group (P<0.05). The positive rate of sputum culture in the ultra early group and early group was significantly lower than that of the late group, and the difference was statistically significant (P<0.05). The mortality of the ultra early group in 3 weeks was significantly lower than that of the late group, and the difference was statistically significant (P<0.05).Conclusion Ultra early tracheotomy can improve the prognosis of patients with massive cerebral hemorrhage and has better clinical effect.%目的 研究大量脑出血手术患者的气管切开时机,改善患者术后预后效果.方法 回顾总结2014年1月—2016年1月在中国医科大学附属第一医院就诊的出血量>50 ml的脑出血患者70例,按照气管切开时机不同分为3组,即超早期气管切开组、早期气管切开组、晚期气管切开组.比较3组患者手术后的颅内再出血发生率,痰培养阳性率,气管套管留置时间,患者的平均住院时间、术后3周内的病死率.结果 超早期气管切开组患者中例患者有1例发生再出血;早期气管切开组中有3例发生再出血;晚期气管切开组患者中2例发生再出血.3组患者的颅内再出血发生率比较差异无统计学意义(P>0.05);超早期和早期气管切开组患者痰培养阳性率明显低于晚期气管切开组患者,差异具有统计学意义(P<0.05).超早期气管切开组患者的气管套管留置时间以及平均住院时间明显低于早期和晚期组,差异具有统计学意义(P<0.05).3组患者术后3周内的病死率差异具有统计学意义(P<0.05).结论 尽早行气管切开手术可以有效改善大量脑出血手术患者的预后,具有明显的临床意义.