气管切开对颅脑损伤患者呼吸力学及血流动力学的影响

发布时间：2018-05-07 14:36

本文选题：气管切开 + 呼吸力学　；参考：《青岛大学》2013年硕士论文

【摘要】：目的探究气管切开对颅脑损伤患者呼吸力学及血流动力学的影响。方法1选择预计需要机械通气超过10天的颅脑损伤患者68例,随机分为A、B、C三组。A组23例,持续经口气管插管；B组24例,插管5天内气管切开；C组21例,插管10-14天气管切开。 2记录气管切开前后24小时气道压力、血气指标及血流动力学指标,计算气管切开前后的肺顺应性,评估2周后格拉斯哥昏迷评分(GCS)、肺部感染评分(CPIS),并记录三组机械通气时间、ICU驻留时间、住院时间和死亡率结果1B、C两组气切后较气切前均有气道峰压降低、动态顺应性及血氧分压增高,差异比较有显著性；平台压、静态顺应性及二氧化碳分压与气切前比较无统计学差异。 2B组较A、C组机械通气时间短,CPIS评分低,GCS评分高,死亡率降低,差异比较有显著性；C与A组机械通气时间、2周CPIS、GCS差异比较无统计学意义,死亡率降低有统计学意义；三组ICU驻留时间及住院时间差异无显著性。 3B、C两组气切前后心率、收缩压、舒张压差异比较均无显著性,平均动脉压较气切前下降,差异有显著性。结论1.气切能降低气道峰压,提高动态顺应性、血氧饱和度及血氧分压；但对平台压、静态顺应性及二氧化碳分压无显著影响。 2.对需要延长机械通气时间的患者,早期气切可以缩短机械通气的时间,降低肺部感染及死亡率；而对ICU驻留时间及住院时间无明显影响。 3.气切不影响心率、收缩压及舒张压,但能有效降低平均动脉压；且通过提高动脉血氧分压,有利于提高GCS,促进脑功能恢复。
[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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15

【参考文献】