Application of early tracheotomy combined with gastrostomy on the prognosis for patients with severe craniocerebral injury
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摘要:
目的 探讨早期气管切开联合胃造瘘术对重型颅脑损伤患者预后的改善作用。 方法 以51例行早期气管切开联合胃造瘘术的重型颅脑损伤术后患者为观察组，未行胃造瘘术的63例患者为对照组，比较两组住院2周后的肺部感染构成比及出院时格拉斯哥评分（GCS）的差异。 结果 术后2周观察组肺部感染的发生率明显低于对照组（P<0.05），且肺部感染与营养状况存在正相关性；出院时观察组和对照组大部分GCS值>8分，而在GCS值≤8分中，观察组明显少于对照组。 结论 早期联合行气管切开术及胃造瘘术可以保持呼吸道通畅，改善重型颅脑外伤术后昏迷患者的肺部感染情况，加强营养支持，改善脑血流量，促进脑功能康复。 Abstract: Objective To explore the application of early tracheotomy combined with gastrostomy on the prognosis for patients with severe craniocerebral injury. Methods Fifty-one cases of severe craniocerebral injury, who received early tracheotomy combined with gatsrostomy, were enrolled as the observation group.The other 61 cases who only received arly tracheotomy but without gatsrostomy were enrolled as the control group. The rates of pneumonia infection after 2 weeks and the GCS scoring were compared. Results At 2 weeks after operation, the incidence of pulmonary infection in the observation group was significantly lower than that in the control group. Pulmonary infection had a positive correlation with nutriture.When discharging,most of the GCS scores were greater than 8. The patients who scored <8 of GCS between the groups was significant. Conclusion The early tracheotomy and gatsrostomy after severe craniocerebral injury surgeryhe manage respiratory track well and it improves pulmonary infection, intensify nutrition suppot and improve rehabilitation of cerebral function.-
Key words:
- severe craniocerebral injury /
- tracheotomy /
- gatsrostomy
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表 1 术后2周肺感染指标与营养指标（
$\, \overline{{x}}{{±}}{{s}}$ ）组别 体温（℃） 白细胞计数（×109/L） 胸片肺部炎性改变（n） 血清总蛋白（g/L） 白蛋白（g/L） 前白蛋白（mg/L） 观察组（n=51） 36.1±1.02 5.1±1.8 1 69.2±16.5 39.4±10.2 305.4±126.5 对照组（n=63） 37.2±1.92 7.3±2.9 9 60.3±13.2 33.2±8.4 261.9±109.4 t/Z -3.921 -2.132 Z=-2.303 6.129 4.329 11.334 P 0.045 0.040 0.021 0.036 0.031 0.003 
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