重度创伤性脑损伤患者早期与晚期气管切开术的比较

Early versus late tracheostomy in patients with severe traumatic head injury.

作者信息

Ahmed Nasim, Kuo Yen-Hong

机构信息

Division of Trauma and Surgical Critical Care, Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey 07754, USA.

出版信息

Surg Infect (Larchmt). 2007 Jun;8(3):343-7. doi: 10.1089/sur.2006.065.

DOI:10.1089/sur.2006.065

PMID:17635057

Abstract

BACKGROUND AND PURPOSE

A majority of patients with severe traumatic brain injury (TBI) need ventilatory support and require endotracheal intubation. There has been substantial debate regarding the timing of tracheostomy. We reviewed our data to determine the impact of early tracheostomy on our resources.

STUDY DESIGN

Retrospective review of a consecutive series of patients with severe TBI treated at a Level II trauma center.

METHOD

All 55 patients admitted to the surgical intensive care unit (ICU) with severe TBI from January, 2002 through September, 2005 were reviewed through the trauma registry. The inclusion criteria were severe TBI with a Glasgow Coma Scale (GCS) score < or = eight points at the time of admission and expected survival for longer than three days. All of these patients required mechanical ventilation and subsequently underwent tracheostomy. According to the timing of tracheostomy, subjects were classified as early group (< or = 7 days; N = 27) or late group (> 7 days; N = 28). The Wilcoxon rank sum test, the log-rank test, and Fisher exact tests were used to compare these groups.

RESULT

The average time of the tracheostomy procedure was 5.5 +/- 1.8 (SD) days in the early group and 11.0 +/- 4.3 days in the late group. There were no significant differences between the groups in terms of age, proportion of female sex, GCS, Injury Severity Score, or need for blood transfusion. However, patients in the early group had a significantly shorter stay in the ICU than patients in the late group (19.0 +/- 7.7 vs. 25.8 +/- 11.8 days; P = 0.008). There was no difference between the groups in ventilator days (15.7 +/- 6.0 vs. 20.0 +/- 16.0 days; p = 0.57). There were no significant differences between the groups regarding overall mortality (15% vs. 4%; p = 0.19), incidence of pneumonia prior to tracheostomy (41% vs. 50%; p = 0.59), median total hospital length of stay (24 days vs. 28 days; p = 0.42), discharged to rehabilitation (74% vs. 82%; p = 0.53), or median total hospital cost (292,329 dollars vs. 332,601 dollars; p = 0.26).

CONCLUSION

Early tracheostomy was beneficial, resulting in a shorter ICU stay.

摘要

背景与目的

大多数重型颅脑损伤（TBI）患者需要通气支持并需进行气管插管。关于气管切开术的时机一直存在大量争论。我们回顾了我们的数据以确定早期气管切开术对我们资源的影响。

研究设计

对在二级创伤中心接受治疗的一系列连续性重型TBI患者进行回顾性研究。

方法

通过创伤登记系统对2002年1月至2005年9月期间收治入外科重症监护病房（ICU）的所有55例重型TBI患者进行回顾。纳入标准为入院时格拉斯哥昏迷量表（GCS）评分≤8分且预期存活超过3天的重型TBI患者。所有这些患者均需要机械通气并随后接受气管切开术。根据气管切开术的时机，将受试者分为早期组（≤7天；n = 27）或晚期组（>7天；n = 28）。采用Wilcoxon秩和检验、对数秩检验和Fisher精确检验对这些组进行比较。

结果

早期组气管切开术的平均时间为5.5±1.8（标准差）天，晚期组为11.0±4.3天。两组在年龄、女性比例、GCS、损伤严重程度评分或输血需求方面无显著差异。然而，早期组患者在ICU的住院时间明显短于晚期组（19.0±7.7天对25.8±11.8天；P = 0.008）。两组在机械通气天数方面无差异（15.7±6.0天对20.0±16.0天；p = 0.57）。两组在总体死亡率（15%对4%；p = 0.19）、气管切开术前肺炎发生率（41%对50%；p = 0.59）、中位总住院时间（24天对28天；p = 0.42）、出院至康复机构（74%对82%；p = 0.53）或中位总住院费用（292,329美元对332,601美元；p = 0.26）方面无显著差异。