标题：早期气道管理对重型颅脑损伤昏迷气道切开患者预后的影响

      作者：周利城，张业司，袁 芳
    (盱眙县中医院神经外科，江苏 盱眙 211700)

      卷次： 2012年23卷24期

      【摘要】 目的 探讨早期气道管理对重型颅脑损伤昏迷患者气道切开的意义。方法 对46例重型颅脑损伤
昏迷患者行气管切开，采取气道湿化、气管内吸痰、减少引起气道刺激的因素等呼吸道管理措施。结果 按GOS
评价标准：1级（良好）9例、2级（轻残）11例、3级（重残）5例、4级（持续植物状态）13例、5级（死亡）8例。气管切开期
间，无一例发生脱管或套管堵塞，18例发生肺部感染，并发症发生率为 39.13% (18/46)。 46例患者气管切开前
PO2、PCO2及SaO2分别为(65.2±8.7) mmHg、(56.2±7.8) mmHg和(92.3±5.1)%，气管切开后分别为(76.5±6.3) mmHg、
(46.1±5.2) mmHg和(97.2±3.1) mmHg，差异具有统计学意义(P<0.05)。结论 对重型颅脑损伤昏迷患者行气管切
开时，尽早行气道管理可显著改善患者通气状况，有效降低气管切开各种并发症的发生。

      【关键词】 重型颅脑损伤；气管切开；呼吸道管理；昏迷

      【中图分类号】 R651.1+5 【文献标识码】 A 【文章编号】 1003—6350（2012）24—053—03<

br>The Effect of early airway management on the prognosis of neurosurgery trauma coma airway cut.
ZHOU
Li-cheng ZHANG Ye-si, YUAN Fang. Department of Neurosurgery, Xuyi Hospital of Chinese Traditional Medicine, Xuyi
211700, Jiangsu, CHINA.

【Abstract】 Objective To investigate the effect of early airway management on the prognosis of neurosurgery
trauma coma airway cut. Methods Forty-Six patients with severe traumatic brain injury coma were performed with
tracheal incision，and airway wet，endotracheal suctioning，and reduce the factors that cause airway irritation and oth-
er respiratory management measures were employed to observe the results. Results According to GOS evaluation
criteria: Ⅰgrade (good) 9 cases，Ⅱgrade (mild disability) 11 cases，Ⅲ grade (severe disability) 5 cases，Ⅳgrade
(persistent vegetative state) 13 cases，Ⅴgrade (death) 8 cases. Tracheotomy during one cases occurred off the pipe or
casing to plug，18 cases with lung infection，complication rate was 39.13% (18/46), and 46 cases before tracheotomy
of PO2，PCO2，and SaO2 were (65.2±8.7) mmHg，(56.2±7.8) mmHg，and (92.3±5.1) mmHg，respectively; after tra-
cheotomy，(76.5±6.3) mmHg, (46.1±5.2) mmHg，and (97.2±3.1) mmHg，respectively, with the statistically signifi-
cant difference (P<0.05). Conclusion Line airway management can significantly improve neurosurgical coma pa-
tients with tracheal incision ventilation, avoid brain tissue hypoxia and cerebral edema, and reduce intracranial pres-
sure，hence can effectively lower the incidece tracheotomy complications.

      【Key words】 Severe traumatic brain injury; Tracheotomy; Respiratory tract; Coma
·临床经验·doi:10.3969/j.issn.1003-6350.2012.24.022