Armstrong P A, McCarthy M C, Peoples J B
Department of Surgery, School of Medicine, Wright State University, Miami Valley Hospital, Dayton, OH 45409, USA.
Surgery. 1998 Oct;124(4):763-6; discussion 766-7. doi: 10.1067/msy.1998.91224.
Early tracheostomy has been advocated for ventilator-dependent patients with blunt trauma, but its advantages have not been examined critically.
We retrospectively reviewed our experience with all patients with blunt trauma undergoing tracheostomy during the 6-year period from 1990 to 1995. Patients undergoing tracheostomy within the first 6 days of hospitalization were designated as early recipients (ET) and those undergoing the procedure at 7 or more days were defined as late recipients (LT).
The entire study group consisted of 157 patients. The ET group contained 62 patients and the LT group contained 95 patients. No statistical differences were noted between the 2 groups with respect to sex distribution, injury severity scores, probability of survival scores, or mortality rates. The mean stay in the intensive care unit for the ET group was 15 days compared with 29 days for the LT group (P < or = .001). The mean total hospital stay for the ET group was 33 days compared with 68 days for the LT group (P < or = .001). The mean estimated per-patient hospital charges for only room and ventilator care were $36,609 for the ET group compared with $73,714 for the LT group.
ET in this patient group resulted in significantly lowered use of resources with no adverse effect on outcome.
对于钝性创伤依赖呼吸机的患者，有人主张早期行气管切开术，但尚未对其优势进行严格检验。
我们回顾性分析了1990年至1995年这6年间所有钝性创伤患者行气管切开术的经验。住院后前6天内行气管切开术的患者被指定为早期接受者（ET），而在第7天或更晚行该手术的患者被定义为晚期接受者（LT）。
整个研究组由157例患者组成。ET组有62例患者，LT组有95例患者。两组在性别分布、损伤严重程度评分、生存概率评分或死亡率方面未发现统计学差异。ET组在重症监护病房的平均住院时间为15天，而LT组为29天（P≤0.001）。ET组的平均总住院时间为33天，而LT组为68天（P≤0.001）。仅病房和呼吸机护理的平均每位患者估计住院费用，ET组为36,609美元，而LT组为73,714美元。
该患者组的早期气管切开术可显著降低资源使用，且对预后无不良影响。
