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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。
Objective To investigate the effect of tracheotomy in different periods on pulmonary infection in patients with severe craniocerebral injury. Methods Ninety-five tracheotomy patients with severe traumatic brain injury were divided into two groups: early tracheotomy group (early group) and late tracheotomy group (late group), 52 patients were divided into two groups according to the time of tracheotomy. Changes in lung infection score (CPIS) at 7 and 28 days after traumatic brain injury, and the proportion of patients with CPIS score ≥6 in both groups. Results In the early tracheotomy group, the CPIS (5.67 ± 0.99) score was lower than that of the late tracheotomy group (6.23 ± 0.68) on the 7th day after traumatic brain injury, and the proportion of patients with CPIS score ≥6 was lower than that of the early tracheotomy The open group was also lower than that of the late tracheotomy group (P <0.05). However, there was no significant difference in CPIS between the two groups at 28 days after craniocerebral injury (P> 0.05) The proportion of 6 patients was lower in early tracheotomy group than in late tracheotomy group (P <0.05). Conclusion Tracheotomy in patients with severe craniocerebral injury within 48 hours is conducive to the control of pulmonary infection and reduce the severity of pulmonary infection, so early tracheotomy for patients with indications of severe craniocerebral injury is recommended.