气管切开术在救治急性重症颅脑损伤中的应用

首都医科大学学报 ›› 2001, Vol. 22 ›› Issue (2): 157-159.

气管切开术在救治急性重症颅脑损伤中的应用

富壮, 王永刚, 赵元立

首都医科大学附属北京天坛医院神经外科

收稿日期:2000-03-23 修回日期:1900-01-01 出版日期:2001-04-15 发布日期:2001-04-15

Tracheotomy in Treatment of Acute Severe Brain Injuries

Fu Zhuang, Wang Yonggang, Zhao Yuanli

Department of Neurosurgery, Beijing Tiantan Hospital, Affiliate of Capital University of Medical Sciences

Received:2000-03-23 Revised:1900-01-01 Online:2001-04-15 Published:2001-04-15

摘要/Abstract

摘要： 为探讨气管切开术在急性重症颅脑损伤救治中的应用价值,对1997年间我院行气管切开的37例急性重症颅脑损伤患者进行了分析.37例患者GCS评分3～8分,其中保守治疗14例,急诊手术治疗23例.气管切开后常规进行了痰培养及药敏试验.结果:37例中生存27例,死亡10例,病死率27.0%.气管切开后94.6%呼吸改善,78.4%动脉血氧饱和度(SaO₂)完全纠正,18.9%SaO₂改善.痰培养显示气管切开后易出现耐药菌株感染,对常用的传统抗生素如青霉素等耐药率高达84.6%,泰能的耐药率最低为14.3%.提示早期气管切开可有效改善通气,纠正低氧血症.气管切开后应常规进行痰培养,根据痰培养结果选择有效的抗生素.经呼吸道给药是防治肺内感染的一种安全有效的方法.

关键词: 颅脑损伤, 气管切开术, 痰培养

Abstract: To summarize the application of tracheotomy in treatment of acute severe brain injuries, 37 cases of acute severe brain injury patients with tracheotomy admitted to the department in 1997 were analyzed. All the scores of GCS were 3 to 8 points. Fourteen cases accepted conservative treatment, other 23 cases with emergency operation. Sputum bacterial cultures and drug sensitive tests were routinely carried out after tracheotomy. Twenty seven cases survived and 10 were dead(27.0%). After tracheotomy, the respirations were improved in 35 cases(94.6%)and SaO₂ turned normal in 29 cases(78.4%). The bactera of pneumonia infections were commonly drug resistant. Tienam had the lowest resistant ratio(14.3%). Sputum bacterial culture should be done routinely after trachotomy and the drugs can be selected according the result. Transtrocheal medication of antibiotics is a safe and effective methold to treat pulmonary infection.

Key words: brain injuries, tracheotomy, sputum bacterial culture

中图分类号:

R651.1⁺5

富壮;王永刚;赵元立. 气管切开术在救治急性重症颅脑损伤中的应用[J]. 首都医科大学学报, 2001, 22(2): 157-159.

Fu Zhuang;Wang Yonggang;Zhao Yuanli . Tracheotomy in Treatment of Acute Severe Brain Injuries[J]. Journal of Capital Medical University, 2001, 22(2): 157-159.

[1]	王莉, 张国军. 血清神经元特异性烯醇化酶与外伤性脑损伤患者及临床特征的关系[J]. 首都医科大学学报, 2021, 42(5): 715-720.
[2]	李康宁, 樊永平, 王蕾. 樊永平教授诊治脑震荡辨证及用药规律研究[J]. 首都医科大学学报, 2019, 40(2): 292-299.
[3]	李力卓, 何松柏, 赵格晶娃. 中老年人群急性单发性创伤性颅脑损伤相关性凝血病的临床分析[J]. 首都医科大学学报, 2018, 39(4): 537-540.
[4]	武元星;孟赜;王强;石广志;张铮;赵立红;郑一;陈光强;周建新. 神经外科患者无支气管镜辅助经皮扩张气管切开术182例临床研究[J]. 首都医科大学学报, 2008, 29(4): 512-515.
[5]	郭彩霞;杜凤和;张立克;陈瑞芬;孙异临. 大鼠颅脑损伤后血管紧张素及其受体变化与B受体阻断剂对其的影响[J]. 首都医科大学学报, 2005, 26(3): 299-302.
[6]	周婷婷;杨昭徐;崔培林. 巯基物质对大鼠急性颅脑损伤应激性胃黏膜损伤胃黏膜结构的影响[J]. 首都医科大学学报, 2003, 24(3): 301-304.
[7]	徐欣萍;王天懿;杨昭徐. 应用奥曲肽治疗颅脑损伤所致应激性溃疡出血[J]. 首都医科大学学报, 2002, 23(3): 232-233.
[8]	袁辉生;张先杰;巢仰云;汪岩. 严重颅脑损伤合并上消化道大出血的治疗[J]. 首都医科大学学报, 2002, 23(3): 234-235.
[9]	于书卿;富壮;赵继宗. 急性颅脑损伤脑脊液中兴奋性氨基酸含量变化的临床分析[J]. 首都医科大学学报, 2001, 22(4): 355-356.
[10]	张东;赵继宗;富壮;唐凯. 创伤性脑室内出血50例分析[J]. 首都医科大学学报, 2000, 21(4): 330-332.
[11]	杜凤和;刘金;张彤;李明月;赵继宗;富壮. 急性颅脑损伤患者心率变异性的临床分析[J]. 首都医科大学学报, 2000, 21(3): 204-205.
[12]	王嵘;王德江;赵元立;富壮. 生长抑素八肽治疗急性重型颅脑损伤后应激性溃疡的疗效分析[J]. 首都医科大学学报, 2000, 21(3): 221-223.
[13]	杜凤和;刘金;高燕;张彤;李明月. 急性颅脑损伤病人心电图QT离散度的临床意义[J]. 首都医科大学学报, 1998, 19(2): 139-140.
[14]	蔡庆华;冯素云. 颌面部创伤性骨折318例临床分析[J]. 首都医科大学学报, 1987, 8(2): 134-137.