Effect of early tracheotomy on severe traumatic brain injury in elderly patients and its influence on prognosis

doi:10.3877/cma.j.issn.2095-9141.2018.06.008

Abstract

Abstract:

Objective

To explore the clinical effect of early tracheotomy in the treatment of severe traumatic brain injury (sTBI) in the elderly and its influence on blood gas index, infection and prognosis.

Methods

One hundred and six elderly patients with sTBI admitted to our hospital from 2016 to 2018 were randomly divided into control group and observation group, 53 cases in each group. All patients were treated with the same basic treatment. The control group received tracheotomy more than 24 h after injury, while the observation group received tracheotomy less than 24 h after injury. The effects of treatment effect, blood gas index changes, hospitalization, pulmonary infection rate and mortality were compared between the two groups.

Results

The duration of mechanical ventilation, ICU hospitalization, total hospitalization time and infection control time in the observation group were significantly less than those in the control group (P<0.05). The incidence of pulmonary infection in the observation group was significantly lower than that in the control group, while the infection control rate was significantly higher than that in the control group, the difference was statistically significant (P<0.05). The levels of PaO₂, PaCO₂, SpO₂ and PaO₂/FiO₂ at 48 h after treatment in both groups were significantly different from those before treatment (P<0.05). The levels of PaO₂, SpO₂ and PaO₂/FiO₂ in the observation group were significantly higher than those in the control group 48 h after treatment (P<0.05), and PaCO₂ levels were significantly lower than those in the control group (P<0.05). There was no significant difference in the distribution of GOS scores between the two groups (P>0.05). There was no significant difference in mortality between the observation group and the control group (P>0.05).

Conclusion

Early tracheotomy less than 24 h after injury is more conducive to improve hypoxemia, ventilation function and brain tissue hypoxia in elderly patients with sTBI, reducing the incidence of pulmonary infection and shortening hospitalization time. It is worth popularizing and applying.

Key words: Early tracheotomy, Severe traumatic brain injury, Blood gas index, Infection

Jinbao Gao, Wende Li, Yunjun Li, Haijiang Wang. Effect of early tracheotomy on severe traumatic brain injury in elderly patients and its influence on prognosis[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 349-352.

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References 16

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组别	病例数	机械通气时间	ICU住院时间	总住院时间
对照组	53	15.36±3.83	19.28±4.52	28.37±6.72
观察组	53	12.47±2.64	15.35±3.46	22.63±5.81
t值	?	4.523	5.026	4.704
P值	?	0.001	0.001	0.001

组别	病例数	机械通气时间	ICU住院时间	总住院时间
对照组	53	15.36±3.83	19.28±4.52	28.37±6.72
观察组	53	12.47±2.64	15.35±3.46	22.63±5.81
t值	?	4.523	5.026	4.704
P值	?	0.001	0.001	0.001

指标	时间	对照组（n=53）	观察组（n=53）	t值	P值
PaO₂（mmHg）	治疗前	45.76±8.52	45.38±8.92	0.224	0.823
?	治疗后48 h	65.83±6.25	74.52±7.06	6.710	0.001
?	t值	13.828	18.922	?	?
?	P值	0.001	0.001	?	?
PaCO₂（mmHg）	治疗前	67.63±8.12	68.25±8.36	0.387	0.699
?	治疗后48 h	57.63±8.93	52.67±8.63	2.908	0.004
?	t值	6.032	9.440	?	?
?	P值	0.001	0.001	?	?
SpO₂（%）	治疗前	81.38±5.95	89.15±4.31	7.699	0.001
?	治疗后48 h	90.73±6.83	95.34±5.52	3.822	0.001
?	t值	7.515	6.435	?	?
?	P值	0.001	0.001	?	?
PaO₂/FiO₂（%）	治疗前	124.87±14.76	121.69±15.26	1.090	0.278
?	治疗后48 h	221.67±17.43	237.87±16.83	4.867	0.001
?	t值	30.854	37.230	?	?
?	P值	0.001	0.001	?	?

指标	时间	对照组（n=53）	观察组（n=53）	t值	P值
PaO₂（mmHg）	治疗前	45.76±8.52	45.38±8.92	0.224	0.823
?	治疗后48 h	65.83±6.25	74.52±7.06	6.710	0.001
?	t值	13.828	18.922	?	?
?	P值	0.001	0.001	?	?
PaCO₂（mmHg）	治疗前	67.63±8.12	68.25±8.36	0.387	0.699
?	治疗后48 h	57.63±8.93	52.67±8.63	2.908	0.004
?	t值	6.032	9.440	?	?
?	P值	0.001	0.001	?	?
SpO₂（%）	治疗前	81.38±5.95	89.15±4.31	7.699	0.001
?	治疗后48 h	90.73±6.83	95.34±5.52	3.822	0.001
?	t值	7.515	6.435	?	?
?	P值	0.001	0.001	?	?
PaO₂/FiO₂（%）	治疗前	124.87±14.76	121.69±15.26	1.090	0.278
?	治疗后48 h	221.67±17.43	237.87±16.83	4.867	0.001
?	t值	30.854	37.230	?	?
?	P值	0.001	0.001	?	?

组别	例数	肺部感染率[例（%）]	感染控制率[例（%）]	控制感染时间（d）
对照组	53	28（52.83）	8（28.57）	13.58±3.52
观察组	53	14（26.41）	12（85.71）	7.28±2.67
t/χ²值	?	7.729	12.218	5.889
P值	?	0.005	0.001	0.001

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