摘要
目的探讨序贯性建立人工气道对重症脑损伤患者救治中的安全性的影响。方法选取2010-04-2014-03入住重症医学科（ICU）时APACHE-Ⅱ评分≥15分、4分≤GCS≤8分、ICU住院时间≥3d、估计气管插管超过3～7d者的重症脑损伤患者44例,随机分为2组,分别按不同方法实施气道开放,试验组采用序贯气道开放法,即在气管切开导管置入气管内之前仍保留气管插管,待气切导管完全正确放置,再拔除气管插管,全过程始终使用呼吸机辅助通气,常规组在气管切开造口过程中不使用呼吸机辅助通气,仅吸氧4～8L/min;观察2组患者的操作时间、APACHE-Ⅱ评分、生命体征、术后24h NSE水平、血气分析以及随访3个月的GOS评分。结果 （1）2组患者入科时、气管切开术前APACHE-Ⅱ、HR、RR、Bp、SpO2比较差异无统计学意义（P〉0.05）;气管切开造口术后与入科时APACHE-Ⅱ、SpO2相比差异均有统计学意义（P〈0.05）;同时气管切开术后APACHE-Ⅱ、HR、RR、Bp、SpO2在2组患者间的差异均有统计学意义（P〈0.05）。（2）2组患者入科时以及气管切开前血气分析中的pH、PaO2、PaCO2和术后NSE水平差异均无统计学意义（P〉0.05）;气管切开造口术后与入科时相比升高,差异有统计学意义（P〈0.05）;对比2组患者的气管切开术后pH、PaO2、PaCO2和术后NSE水平差异具有统计学意义（P〈0.05）。（3）2组患者3个月后生存质量相比差异有统计学意义（P〈0.05）。结论重症脑损伤患者因长期呼吸机辅助通气,采取序贯性人工气道开放法能确保其安全性,改善预后,提高抢救成功率。
Objective To study the safety of sequential artificial airway in treatment of severe traumatic brain inju ry. Methods Forty-four patients with severe traumatic brain injury treated in ICU department from May 2010 to April 2014 were selected. All patients had the APACHE Ⅱ scores of over 15 points, GCS scores from 4 to 8 points, hospitalization stays of more than 3 days and tracheal intubation time of over 3-7 days, who were divided into two groups. Patients in the study group received sequential artificial airway and were given assisted ventilation by using breathing machine, while others in the control group were just treated by oxygen inhalation with velocity of 4-8 L/min. The operation time, APACHE-II score, vital signs, the level of serum NSE after 24 hours, blood gas analysis and three-month-follow-up GOS scores in the two groups were observed. Results Before tracheotomy, there were no significant differences as for ACHE-Ⅱ score, HR, RR, BP, SaO2 between the two groups （P〉0.05） ; while the APACHE Ⅱ score, SpO2 value showed significant differences after tracheotomy compared with that before tracheotomy （P〈0.05）, furthermore, APACHE Ⅱ score, HR, RR, BP, SaO2 between the two groups after tracheotomy presented statistical differences （P〈0.05）. Both blood-gas analysis of pH, PaO2, PaCO2 of the two groups and the level of NSE before tracheotomy showed no significant differences （P〉0.05）, which were significantly increased after tracheotomy （P〈0.05） and which showed statistical differences between two groups after tracheotomy （P〈 0.05）. The quality of life after three months was significantly different between the two groups （P〈0.05）. Conclusion Because of the long-term mechanical ventilation, using the sequential artificial airway can guarantee safety, which can improve the successful rate of rescue and improve the prognosis of severe traumatic brain injury.
出处
《中国实用神经疾病杂志》
2016年第10期1-3,共3页
Chinese Journal of Practical Nervous Diseases
基金
江苏省泰州市社会发展项目(2012年)
