Effect of tracheotomy at different opportunities on pulmonary infection of patients with heavy cranicerebral injury

doi:10.3877/cma.j.issn.1674-1358.2020.05.009

Abstract

Abstract:

Objective

To explore the influence of tracheotomy timing on pulmonary infection in patients with severe head injury (HCI), and to provide clinical basis for more effective treatment.

Methods

Total of 160 patients with severe craniocerebral injury admitted to the Fifth Affiliated Hospital (Zhuhai) of Zunyi Medical University from January 2016 to December 2018 were selected, and divided into observation group (80 cases) and control group (80 cases) according to the different timing of tracheotomy. The cases in observation group were given tracheotomy within 24 hours (early) of craniocerebral injury, while the cases in control group were given tracheotomy after 24 hours (late) of craniocerebral injury. The pathogenic bacteria composition and infection control of the two groups of patients with pulmonary infection were observed, and the clinical efficacy and pulmonary ventilation function before and after surgery were compared, respectively.

Results

The incidences of adverse reactions such as pulmonary infection (33.75%), subcutaneous emphysema (8.75%), hypoxemia (3.75%), hemorrhage (10.00%), esophago-tracheal fistula (6.25%) and pneumothorax (6.25%) of cases in observation group with early tracheotomy were significantly lower than those of the control group with late tracheotomy (61.25%, 20.00%, 13.75%, 25.00%, 21.25%, 16.25%), with significant differences (χ² = 12.13, P < 0.001; χ² = 4.11, P = 0.04; χ² = 4.10, P = 0.04; χ² = 6.23, P = 0.01; χ² = 7.59, P = 0.01; χ² = 6.01, P = 0.01). Gram-negative bacteria (60.00%, 51/85) were predominant in pulmonary infections of severe craniocerebral injury and Pseudomonas aeruginosa was predominant (25.88%, 22/85). Staphylococcus aureus (23.53%, 20/85) was predominant in Gram-positive bacteria (34.12%, 29/85) and Candida albicans (4.71%, 4/85) was predominant in fungal infection (5.88%, 5/85). The recovery rate of HCI pulmonary infection after early tracheotomy (77.28%, 21/27) was significantly higher than that of control group (32.66%, 16/49) and the overall survival rate (88.89%, 24/27) was also higher than that of control group (67.36%, 33/49), with significant differences (χ² = 14.18, P < 0.001; χ² = 4.38, P = 0.04). PO₂ of patients in observation group [(128.22 ± 11.79) mmHg] and SaO₂ [ (96.55 ± 1.41)%] were higher than those in control group with tracheotomy [ (101.35 ± 10.27) mmHg] and [ (94.26 ± 1.64)%], with significant differences (t = 15.37, P < 0.001; t = 9.47, P < 0.001). PCO₂ of patients in observation group [ (35.79 ± 5.33) mmHg] was significantly lower than that of patients in control group [(43.72 ± 6.06) mmHg], with significant difference (t = 8.77, P < 0.001).

Conclusions

Early tracheotomy in patients with severe craniocerebral injury could effectively improve the clinical therapeutic effect, reduce complications and improve the prognosis of patients.

Key words: Tracheotomy, Severe cranicerebral injury, Pulmonary infection

Jinhong Xiao, Binglan Hu, Zhongming Huang, Xu Wang, Haijun Liu. Effect of tracheotomy at different opportunities on pulmonary infection of patients with heavy cranicerebral injury[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(05): 406-410.

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References 28

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组别	例数	肺部感染	皮下气肿	低氧血症	出血	食管气管瘘	气胸
观察组	80	27（33.75）	7（8.75）	3（3.75）	8（10.00）	5（6.25）	5（6.25）
对照组	80	49（61.50）	16（20.00）	10（13.75）	20（25.00）	17（21.25）	13（16.25）
χ²值		12.13	4.11	4.10	6.23	7.59	6.01
P值		< 0.001	0.04	0.04	0.01	0.01	0.01

组别	例数	肺部感染	皮下气肿	低氧血症	出血	食管气管瘘	气胸
观察组	80	27（33.75）	7（8.75）	3（3.75）	8（10.00）	5（6.25）	5（6.25）
对照组	80	49（61.50）	16（20.00）	10（13.75）	20（25.00）	17（21.25）	13（16.25）
χ²值		12.13	4.11	4.10	6.23	7.59	6.01
P值		< 0.001	0.04	0.04	0.01	0.01	0.01

病原菌		株数（%）
革兰阳性菌		29（34.12）
	金黄色葡萄球菌	20（23.53）
	其他	9（10.59）
革兰阴性菌		51（60.00）
	铜绿假单胞菌	22（25.88）
	肺炎克雷伯菌	9（10.59）
	鲍曼不动杆菌	10（11.76）
	大肠埃希菌	3（3.53）
	其他	7（8.24）
真菌		5（5.88）
	白假丝酵母菌	4（4.71）
	其他	2（1.17）
合计		85（100.00）

病原菌		株数（%）
革兰阳性菌		29（34.12）
	金黄色葡萄球菌	20（23.53）
	其他	9（10.59）
革兰阴性菌		51（60.00）
	铜绿假单胞菌	22（25.88）
	肺炎克雷伯菌	9（10.59）
	鲍曼不动杆菌	10（11.76）
	大肠埃希菌	3（3.53）
	其他	7（8.24）
真菌		5（5.88）
	白假丝酵母菌	4（4.71）
	其他	2（1.17）
合计		85（100.00）

组别	例数	显著有效	有效	无效	死亡	总有效率	生存率
观察组	27	8（29.63）	13（48.15）	3（11.11）	3（11.11）	21（77.78）	24（88.89）
对照组	49	7（14.29）	9（18.37）	17（34.70）	16（32.64）	16（32.66）	33（67.36）
χ²值		2.59	7.51	4.99	4.31	14.18	4.38
p		0.11	0.01	0.03	0.04	< 0.001	0.04

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