气管切开机械通气治疗多发伤合并肺挫伤临床分析

摘要

Objective To analyze the clinical effect of mechanical ventilation of tracheotomy treatment of multiple trauma with pulmonary contusion.Methods 68 patients with multiple trauma combined pulmonary contusion in 500 patients with multiple trauma,who were selected as the research objects in our hospital from December 1995 to December 2010,were divided into tracheotomy group and non-tracheotomied group,with 34 cases in each group.To monitor the dynamic change of the patients regained consciousness,the subjective symptom,the vital signs of heart rate,rhythm,hematoid saturation,and blood pressure,the blood gas analysis,the oxygen index,and the X-ray appeara. To record all the research objects of the damage location,the injury severity score(ISS) which was the square sum of Indian physic AIS score as the evaluation standard of Abbreviated Injury Scale(AIS-90),the average using time of ventilator,the ICU monitoring time,the mortality within 1 month postoperative. Results The difference of damage location before operation in tracheotomy group compared with which in non-tracheotomied group was no statistical significance(P>0.05).The average using time of ventilator,the ICU monitoring time in tracheotomy group were shorter than which in non-tracheotomied group,the mortality within 1 month in tracheotomy group was less than which in non-tracheotomied group,the differences were statistical significance(P<0.05).ConclusionMultiple trauma combined pulmonary contusion has the complexity of treatment,has less attention to pulmonary contusion to delay the disease,should be treated with tracheotomy early,has significant effect to prevent ARDS,could improve ventilation,prevent atelectasis,eliminate secretion of small airway,prevent pulmonary infection.%目的：分析气管切开机械通气治疗多发伤合并肺挫伤临床疗效。方法1995年12月～2010年12月我院共收治多发伤500余例，选取68例合并肺挫伤病例作为研究对象，分为气管切开组（34例）和非切开组（34例），全程对监测患者神志和自觉症状、生命体征（心率、心律、血氧饱和度、血压）、血气分析、末梢氧饱和度、X线影像学等动态变化。记录所有研究对象（1）损伤部位；（2）损伤严重度评分按《简明损伤等级AIS-90标准》取全身最重的3个区域AIS分值的平方和。（3）平均呼吸机使用时间；（4）ICU监护时间；（4）术后1个月内死亡率。结果手术前与气管切开组比较，未切开组的损伤部位虽有差异，但无统计学意义（P＞0.05）；与非气管切开组比较，气管切开组平均呼吸机使用时间以及ICU监护时间明显缩短，差异有统计学意义（P＜0.05）；与非气管切开组比较，气管切开组术后1个月内死亡率明显减小，差异有统计学意义（P＜0.05）。结论多发性复合伤合并肺挫伤患者治疗复杂，往往对肺挫伤处理重视不够延误病情，应该尽早气管切开，对于防止ARDS发生有有显著效果，改善通气，防止肺不张，排除小气道分泌物，防止肺部感染。