探讨高分级（Hunt-Hess Ⅳ~Ⅴ级）动脉瘤性蛛网膜下腔出血（aSAH）患者行气管切开术的时机及其对临床预后的影响。

回顾性分析宝鸡市中心医院神经外科自2015年1月至2020年6月收治的53例高分级aSAH患者为研究对象。根据气管切开时机将患者分为超早期组（24 h内，32例）和早期组（1~7 d，21例），超早期组于aSAH后24 h内实施气管切开术，早期组于aSAH后1~7 d行气管切开术。比较2组患者神经系统、呼吸系统、气管切开术等相关并发症发生率，以及机械通气、NICU住院时间等临床指标，于发病后6个月采用改良Rankin量表（mRS）评估神经功能恢复情况。

2组患者术后发生癫痫、脑梗死、颅内再出血、尿路感染、脓毒症、颅内感染、皮下气肿的发生率及PCO₂比较，差异均无统计学意义（P>0.05）；与早期组比较，超早期组患者术后发生胸腔积液、肺部感染、深静脉血栓栓塞的发生率均降低，机械通气时间、堵管时间及NICU住院时间均缩短，血气分析PO₂增高，差异均有统计学意义（P<0.05）。随访6个月，2组患者的mRS评分、死亡率比较，差异均无统计学意义（P>0.05）。

高分级aSAH患者超早期气管切开可有效降低肺部感染的发生几率，改善患者的呼吸功能，保障组织器官供氧，减少机械通气时间，缩短NICU住院时间，且不增加aSAH手术患者的死亡率和神经功能障碍程度。

To investigate the timing of tracheotomy in patients with high-grade (Hun-Hess grade Ⅳ-Ⅴ) aneurysmal subarachnoid hemorrhage (aSAH) and its impact on clinical prognosis.

A retrospective analysis was conducted on 53 patients with aSAH admitted to Neurosurgery Department of Baoji Central Hospital from January 2015 to June 2020. The patients were divided into an ultra-early group (32 cases) and an early group (21 cases) according to the timing of tracheotomy. Patients in the ultra-early group underwent tracheostomy within 24 h after aSAH, while those in the early group underwent tracheostomy 1-7 d after aSAH. The incidence of complications related to the nervous system, respiratory system, tracheotomy, as well as indicators such as mechanical ventilation duration and NICU stay, were compared between the two groups. Neurological function recovery was evaluated using the modified Rankin scale (mRS) at 6 months after onset.

There was no significant difference in the occurrence of postoperative epilepsy, cerebral infarction, intracranial rebleeding, pneumothorax, urinary tract infection, sepsis, intracranial infection, incision infection, airway stenosis, subcutaneous emphysema, PCO₂, and bedsores between the two groups of patients. Compared with the early group, the incidence of postoperative pleural effusion, pulmonary infection, and deep vein thrombosis was reduced, the duration of mechanical ventilation, tube blockage, and NICU hospitalization was shortened, and blood gas levels of PO₂ were increased in the ultra-early group, with statistically significant differences (P<0.05). At a 6-month follow-up, there was no statistically significant difference in mRS scores and mortality rates between the two groups of patients (P>0.05).

Ultra early tracheostomy in high-grade aSAH patients can effectively reduce the incidence of pulmonary infection, improve respiratory function, ensure oxygen supply to tissues and organs, reduce mechanical ventilation time, shorten NICU hospitalization time, and do not increase the mortality rate and neurological dysfunction of aSAH surgery patients.