【摘要】：目的：探討腦干損傷后不同時機下行氣管切開術對患者治療效果及治療過程的影響。方法：選取腦干損傷后給予氣管切開患者79例,依據是否在腦干損傷72小時以內給予氣管切開,分為A、B兩組,其他治療相同。將兩組資料對比分析,研究腦干損傷后不同時機行氣管切開術對患者治療效果及過程的影響。結果：從治療效果上來看,A、B兩組患者在清醒率、持續(xù)意識障礙率及死亡率上的差異無統(tǒng)計學意義(P=0.657)；對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機行氣管切開間的治療效果的差異有統(tǒng)計學意義(P=0.011),腦外傷所致腦干損傷患者在不同時機行氣管切開間的治療效果的差異有統(tǒng)計學意義(P=0.001)。從治療過程上來看,(1)在最終清醒的患者中,不同時機行氣管切開術下患者清醒所用的時間無統(tǒng)計學意義(P=0.620)；(2)在持續(xù)意識障礙的患者中,不同時機行氣管切開術下患者格拉斯哥評分的恢復無統(tǒng)計學意義(P=-0.153)；(3)在最終死亡的患者中,不同時機行氣管切開術下患者生存時間的差異比較的P值(P=0.057)接近0.05,因樣本量較少,有待進一步擴大樣本含量,方可下結論。結論：并非所有的腦干損傷患者都能從早期氣管切開中受益。不同病因導致的腦干損傷在不同時機下行氣管切開術的治療效果可能存在差異。氣管切開時機不同的清醒的患者,其清醒所用的時間可能無差異。氣管切開時機不同的持續(xù)意識障礙的患者,格拉斯哥評分恢復的情況可能無差異。
[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.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R651.15

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