改良经皮气管旋切术对重症脑出血昏迷患者手术指标、早期意识水平及生活质量的影响

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摘要目的探讨改良经皮气管旋切术对重症脑出血昏迷患者手术指标、早期意识水平及生活质量的影响。方法选取2016年1月～2020年2月广东省肇庆市怀集县人民医院神经外科收治的140 例重症脑出血昏迷患者作为研究对象，以随机数字表法将其分为对照组与研究组，每组各70 例。对照组行常规气管切开术，研究组行改良经皮气管旋切术。采用脑电双频指数（BIS）、格拉斯哥昏迷评分量表（GCS）评估两组患者的早期意识水平，采用生活质量量表（SF-36）评估两组患者的生活质量。随访3 个月，比较两组患者的手术相关指标、早期意识水平以及术前、术后3 个月的生活质量变化。结果研究组患者的切口大小小于对照组，手术时间短于对照组，术中出血量、丙泊酚使用量少于对照组，差异有统计学意义（P＜0.05）。研究组患者术后的BISmean、GCSmean 与对照组比较，差异无统计学意义（P＞0.05）；研究组患者术后的BISmax 低于对照组，BISmin 高于对照组，差异有统计学意义（P＜0.05）。两组患者术前的生理职能、心理功能、认知功能、情绪功能、角色功能、总生活质量评分比较，差异无统计学意义（P＞0.05）；术后3 个月，两组患者的生理职能、心理功能、认知功能、情绪功能、角色功能、总生活质量评分高于本组术前，且研究组患者术后3 个月的生理职能、心理功能、认知功能、情绪功能、角色功能、总生活质量评分高于对照组，差异有统计学意义（P＜0.05）。结论相对于常规气管切开术，改良经皮气管旋切术的手术操作时间较短，且切口小、术中出血量少、麻醉药物使用量较少，可更有效地改善重症脑出血昏迷患者的早期意识水平，提高患者生活质量。

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关键词 ：改良经皮气管旋切术, 脑出血, 昏迷, 手术指标, 早期意识, 生活质量

Abstract：Objective To explore the effect of modified percutaneous tracheostomy on the surgical index, early consciousness level and quality of life in patients with severe cerebral hemorrhage and coma. Methods A total of 140 patients with severe cerebral hemorrhage and coma treated in the Department of Neurosurgery, People′s Hospital of Huaiji County in Zhaoqing City, Guangdong Province from January 2016 to February 2020 were selected as the research objects, and divided into control group and study group by random number table method, with 70 cases in each group.The patients in control group underwent conventional tracheostomy, and the study group underwent modified percutaneous tracheostomy. The bispectral index (BIS) and Glasgow coma scale (GCS) were used to assess the level of early consciousness, and the short-form 36 item health survey questionnaire (SF-36) was used to assess the quality of life.Followed up for 3 months, the surgery-related indicators, early consciousness level, and quality of life changes before and after 3 months of operation between the two groups were compared. Results The incision size of the study group was smaller than that of the control group, the operation time was shorter than that of the control group, the intraoperative blood loss and propofol usage were lesser than those of the control group, and the differences were statistically significant (P＜0.05). There were no statistically significant differences in the postoperative BISmean and GCSmean between the study group and the control group (P＞0.05).The postoperative BISmax of the study group was lower than that in the control group, and the BISmin was higher than that in the control group, and the differences were statistically significant (P＜0.05). There were no statistically significant differences in physiological function, psychological function, cognitive function, emotional function, role function, and total quality of life scores between the two groups before operation (P＞0.05). Postoperative 3 months, the physiological function, psychological function, cognitive function, emotional function, role function, the total quality of life scores were higher than those preoperative, and the differences were statistically significant (P＜0.05). Postoperative 3 months,the physiological function, psychological function, cognitive function, emotional function, role function, the total quality of life scores of the study group were higher than those of the control group, and the differences were statistically significant (P＜0.05). Conclusion Compared with conventional tracheotomy, modified percutaneous tracheostomy has a shorter operation time, smaller incision, less intraoperative blood loss, and less anesthetic use, which can effectively improve the early consciousness of patients with severe cerebral hemorrhage and coma, and improve the quality of life.

Key words： Modified percutaneous tracheostomy Cerebral hemorrhage Coma Surgical indicators Early awareness;Quality of life

基金资助:广东省肇庆市科技创新计划项目（2014E229）

作者简介: 李宝嘉（1975-），男，广东肇庆人，本科，副主任医师，神经外科副主任，主要从事神经外科疾病诊疗工作

引用本文:

李宝嘉;孙新林; 莫泉;赖为峰;周秀传. 改良经皮气管旋切术对重症脑出血昏迷患者手术指标、早期意识水平及生活质量的影响[J]. 中国当代医药, 2020, 27(25): 65-69.
LI Bao-jia;SUN Xin-lin;MO Quan; LAI Wei-feng; ZHOU Xiu-chuan. Effect of modified percutaneous tracheostomy on the surgical index, early consciousness level and quality of life in patients with severe cerebral hemorrhage and coma. 中国当代医药, 2020, 27(25): 65-69.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2020/V27/I25/65

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