Effect Of Early Postoperative Tracheotomy On Treatment And Pulmonary Infection In Patients With Spontaneous Intracerebral Hemorrhage

Objective:To explore the effect of early postoperative tracheotomy for patients with spontaneous cerebral hemorrhage(SICH)on the treatment effect during hospitalization and pulmonary infection,so as to guide the correct application of tracheotomy in the actual clinical work of neurosurgery.Methods:1.A total of 116 patients with spontaneous intracerebral hemorrhage(SICH)who received surgical treatment(intracranial hematoma removal and endoscopic intracerebral hematoma removal)and underwent tracheotomy in the neurosurgery department of Cheng De central hospital from June 2014 to December 2019 were included,and 10 patients were excluded according to the exclusion criteria.2.The remaining 106 patients were grouped according to the actual timing of postoperative tracheotomy,which was based on the classification method generally agreed by most scholars at home and abroad(early and non-early tracheotomy was defined before and after 24 h after intracerebral hemorrhage).Forty-nine patients who underwent tracheotomy within 24 hours after surgery were in the early group,while 57 patients who underwent tracheotomy 24 hours after surgery were in the control group.3.General clinical data,pulmonary infection incidence,fatality rate,pulmonary infection control rate,pulmonary infection control time,ICU treatment time,GCS score before tracheotomy and GCS score 1 week after tracheotomy were collected for both groups.The statistical data were sorted out and carefully checked.Finally,SPSS22.2 software was applied to conduct statistical analysis on all the data,and P < 0.05 was considered as statistically significant.Results:1.There was no significant difference in age,gender,intracerebral hemorrhage,GCS score on admission and other indicators between the two groups(P >0.05),and the data of the two groups were comparable.2.The early group during the period of the treatment of pulmonary infection after tracheotomy rate was 32.7%,significantly lower than 63.2% in the control group,the early pulmonary infection control group(87.5%)compared with control group(55.6%)increased,the early group case fatality rate of 12.2%,while the control group(35.1%)had significantly higher than the fatality rate of statistically significant difference(P < 0.05).3.The control time of pulmonary infection in the early group(9.57±1.45)d was less than that in the control group(15.45±3.82)d,and the ICU admission time in the early group(9.23±2.01)d was also significantly lower than that in the control group(11.35±2.20)d,with statistically significant differences(P < 0.05).4.In the absence of tracheotomy,the GCS score of the early group was(4.19±0.70)points,while that of the control group was(4.12±0.74)points,with no significant difference(P >,0.05).And when to continue after a week of standardized treatment,the early group of patients with GCS score rebound is(6.44±1.33)points,control group patients with GCS score increase to(5.65±1.58)points,two groups of patients with GCS score increased when their less gas cutting,and early late the increase of GCS score to a greater extent than group,difference has statistical significance(P < 0.05).Conclusion:1.In the treatment process of patients after spontaneous intracerebral hemorrhage,tracheotomy in the early stage(within 24 hours after surgery)can effectively reduce the probability of pulmonary infection in the later stage and reduce the mortality during treatment,which is conducive to controlling the aggravation of pulmonary infection and curing the pulmonary infection in a shorter time.In addition,it can also shorten the time of ICU treatment for patients and play a positive role in the recovery of patients' consciousness,which is worthy of recommendation in the clinical work of neurosurgery.2.Because after tracheotomy in patients with airway self-purification ability is limited,many late treatment such as sputum suction and using breathing machine with therapeutic operations if the implementation is not appropriate,its itself will also be a cause of lung infection is an important risk factor,so it is necessary for patients under the premise of early tracheotomy,medical personnel must strictly abide by the sterile operation specification,strengthening the patient's airway nursing,avoid iatrogenic infection,in the process of the treatment of cerebral hemorrhage patients with postoperative maximum play to the advantages of early tracheotomy.