【摘要】：目的：探討腦干損傷后不同時(shí)機(jī)下行氣管切開(kāi)術(shù)對(duì)患者治療效果及治療過(guò)程的影響。方法：選取腦干損傷后給予氣管切開(kāi)患者79例,依據(jù)是否在腦干損傷72小時(shí)以?xún)?nèi)給予氣管切開(kāi),分為A、B兩組,其他治療相同。將兩組資料對(duì)比分析,研究腦干損傷后不同時(shí)機(jī)行氣管切開(kāi)術(shù)對(duì)患者治療效果及過(guò)程的影響。結(jié)果：從治療效果上來(lái)看,A、B兩組患者在清醒率、持續(xù)意識(shí)障礙率及死亡率上的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.657)；對(duì)A、B兩組患者在不同病因上分層比較,腦出血所致腦干損傷患者在不同時(shí)機(jī)行氣管切開(kāi)間的治療效果的差異有統(tǒng)計(jì)學(xué)意義(P=0.011),腦外傷所致腦干損傷患者在不同時(shí)機(jī)行氣管切開(kāi)間的治療效果的差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。從治療過(guò)程上來(lái)看,(1)在最終清醒的患者中,不同時(shí)機(jī)行氣管切開(kāi)術(shù)下患者清醒所用的時(shí)間無(wú)統(tǒng)計(jì)學(xué)意義(P=0.620)；(2)在持續(xù)意識(shí)障礙的患者中,不同時(shí)機(jī)行氣管切開(kāi)術(shù)下患者格拉斯哥評(píng)分的恢復(fù)無(wú)統(tǒng)計(jì)學(xué)意義(P=-0.153)；(3)在最終死亡的患者中,不同時(shí)機(jī)行氣管切開(kāi)術(shù)下患者生存時(shí)間的差異比較的P值(P=0.057)接近0.05,因樣本量較少,有待進(jìn)一步擴(kuò)大樣本含量,方可下結(jié)論。結(jié)論：并非所有的腦干損傷患者都能從早期氣管切開(kāi)中受益。不同病因?qū)е碌哪X干損傷在不同時(shí)機(jī)下行氣管切開(kāi)術(shù)的治療效果可能存在差異。氣管切開(kāi)時(shí)機(jī)不同的清醒的患者,其清醒所用的時(shí)間可能無(wú)差異。氣管切開(kāi)時(shí)機(jī)不同的持續(xù)意識(shí)障礙的患者,格拉斯哥評(píng)分恢復(fù)的情況可能無(wú)差異。
[Abstract]:Objective: to investigate the effect of tracheotomy after brain stem injury. Methods: Seventy-nine patients with brain stem injury were treated with tracheotomy. According to whether the patients were given tracheotomy within 72 hours after brain stem injury, they were divided into two groups: group A and group B, other treatments were the same. The effect of tracheotomy at different time after brain stem injury on the treatment effect and process of patients was studied by comparing and analyzing the data of the two groups. Results: there was no significant difference in the rate of wakefulness, the rate of persistent disturbance of consciousness and the death rate between the two groups (P0. 657). There was significant difference in the therapeutic effect between the patients with brain stem injury caused by intracerebral hemorrhage in different time after tracheotomy (P0. 011). There was significant difference in the therapeutic effect between the patients with brain stem injury after tracheotomy at different time (P0. 001). From the point of view of the treatment process, (1) there was no significant difference in the time taken for the patients to wake up under tracheotomy at different times (P0. 620). (2) the recovery of Glasgow score in patients with persistent disturbance of consciousness was not statistically significant under tracheotomy at different times (Pfi-0.153). (3) among the patients with final death, the difference of survival time between the patients undergoing tracheotomy at different times (P0. 057) was close to 0. 05. Because of the small sample size, the sample size needed to be further expanded before the conclusion could be drawn. Conclusion: not all brain-stem injury patients benefit from early tracheotomy. The effect of tracheotomy on brain stem injury caused by different etiology may be different. There may be no difference in the duration of recovery in patients with different tracheotomy timing. There may be no difference in the recovery of Glasgow score in patients with persistent consciousness disorders at different tracheotomy times.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R651.15

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