本文選題：氣管切開(kāi) + 呼吸力學(xué)　； 參考：《青島大學(xué)》2013年碩士論文

【摘要】：目的探究氣管切開(kāi)對(duì)顱腦損傷患者呼吸力學(xué)及血流動(dòng)力學(xué)的影響。 方法1選擇預(yù)計(jì)需要機(jī)械通氣超過(guò)10天的顱腦損傷患者68例,隨機(jī)分為A、B、C三組。A組23例,持續(xù)經(jīng)口氣管插管；B組24例,插管5天內(nèi)氣管切開(kāi)；C組21例,插管10-14天氣管切開(kāi)。 2記錄氣管切開(kāi)前后24小時(shí)氣道壓力、血?dú)庵笜?biāo)及血流動(dòng)力學(xué)指標(biāo),計(jì)算氣管切開(kāi)前后的肺順應(yīng)性,評(píng)估2周后格拉斯哥昏迷評(píng)分(GCS)、肺部感染評(píng)分(CPIS),并記錄三組機(jī)械通氣時(shí)間、ICU駐留時(shí)間、住院時(shí)間和死亡率 結(jié)果1B、C兩組氣切后較氣切前均有氣道峰壓降低、動(dòng)態(tài)順應(yīng)性及血氧分壓增高,差異比較有顯著性；平臺(tái)壓、靜態(tài)順應(yīng)性及二氧化碳分壓與氣切前比較無(wú)統(tǒng)計(jì)學(xué)差異。 2B組較A、C組機(jī)械通氣時(shí)間短,CPIS評(píng)分低,GCS評(píng)分高,死亡率降低,差異比較有顯著性；C與A組機(jī)械通氣時(shí)間、2周CPIS、GCS差異比較無(wú)統(tǒng)計(jì)學(xué)意義,死亡率降低有統(tǒng)計(jì)學(xué)意義；三組ICU駐留時(shí)間及住院時(shí)間差異無(wú)顯著性。 3B、C兩組氣切前后心率、收縮壓、舒張壓差異比較均無(wú)顯著性,平均動(dòng)脈壓較氣切前下降,差異有顯著性。 結(jié)論1.氣切能降低氣道峰壓,提高動(dòng)態(tài)順應(yīng)性、血氧飽和度及血氧分壓；但對(duì)平臺(tái)壓、靜態(tài)順應(yīng)性及二氧化碳分壓無(wú)顯著影響。 2.對(duì)需要延長(zhǎng)機(jī)械通氣時(shí)間的患者,早期氣切可以縮短機(jī)械通氣的時(shí)間,降低肺部感染及死亡率；而對(duì)ICU駐留時(shí)間及住院時(shí)間無(wú)明顯影響。 3.氣切不影響心率、收縮壓及舒張壓,但能有效降低平均動(dòng)脈壓；且通過(guò)提高動(dòng)脈血氧分壓,有利于提高GCS,促進(jìn)腦功能恢復(fù)。
[Abstract]:Objective to investigate the effect of tracheotomy on respiratory mechanics and hemodynamics in patients with craniocerebral injury. Methods 1Sixty-eight patients with craniocerebral injury who were expected to need mechanical ventilation for more than 10 days were randomly divided into group A (n = 23), group B (n = 24) with continuous tracheal intubation, group C (n = 21) with tracheotomy within 5 days after intubation, and group C (n = 21) with tracheotomy for 10-14 days. 2the airway pressure, blood gas and hemodynamics were recorded 24 hours before and after tracheotomy, and lung compliance was calculated before and after tracheotomy. Two weeks later, Glasgow coma score (Glasgow coma score), pulmonary infection score (CPISI) were evaluated, and the duration of mechanical ventilation and the duration of ICU stay, hospital stay and mortality were recorded. Results 1There were significant differences in peak airway pressure, dynamic compliance and partial pressure of oxygen between two groups after gas resection, but there was no significant difference in plateau pressure, static compliance and partial pressure of carbon dioxide between two groups. The mechanical ventilation time of group 2B was shorter than that of group A and CPIS score was lower than that of group A. The GCS score of group 2B was lower than that of group A, and the mortality rate was lower than that of group A. There was no significant difference between group C and group A in the duration of mechanical ventilation and CPIS-GCS in group A (2 weeks), and the decrease of mortality was statistically significant. There was no significant difference in resident time and hospitalization time of ICU among the three groups. 3There was no significant difference in heart rate, systolic blood pressure and diastolic pressure between the two groups before and after gas resection, but the mean arterial pressure was lower than that before gas resection, and the difference was significant. Conclusion 1. Gas shear can reduce peak airway pressure, improve dynamic compliance, blood oxygen saturation and partial pressure of oxygen, but has no significant effect on plateau pressure, static compliance and carbon dioxide partial pressure. 2. For patients who need to prolong the time of mechanical ventilation, early pneumotomy can shorten the time of mechanical ventilation, reduce pulmonary infection and mortality, but have no significant effect on the duration of stay and hospitalization of ICU. 3. Gas cut does not affect heart rate, systolic pressure and diastolic pressure, but can effectively reduce the mean arterial pressure, and by increasing the partial pressure of arterial oxygen, it is helpful to improve GCSs and promote the recovery of brain function.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R651.15

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