【摘要】 目的探讨机械通气辅助治疗重度颅脑损伤的效果。方法 82例伴有环池结构消失的重度颅脑损伤患者,随机分为观察组与对照组,每组41例。对照组患者采用常规治疗,观察组在常规治疗的基础上给予机械通气辅助治疗。比较两组患者的治疗效果。结果治疗前两组患者格拉斯哥昏迷评分（GCS）、颅内压（ICP）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）比较差异无统计学意义（P>0.05）;治疗后24 h观察组GCS评分、ICP、PaO₂、PaCO₂、SaO₂均优于对照组,差异均具有统计学意义（P<0.05）。观察组预后良好率为43.90%,高于对照组的21.95%,差异具有统计学意义（P<0.05）。两组患者术前CT影像学表现均存在脑干受压并环池消失的表现,术后1 d复查颅脑CT均见脑干受压较术前减轻,环池较术前略清晰,两组间差异不明显,术后1周复查颅脑CT见观察组较对照组脑组织缺氧及水肿减轻,且脑干形态规整,环池更清晰。结论重度颅脑损伤患者应用机械通气辅助治疗,对改善患者各项指标与预后情况均可发挥重要作用,可在临床实践中推广应用。更多还原

【Abstract】 Objective To discuss the effect of mechanical ventilation in adjuvant treatment of severe craniocerebral injury. Methods A total of 82 severe craniocerebral injury patients with the disappearance of cisterna ambiens structure were randomly divided into observation group and control group, with 41 cases in each group. The control group was treated with conventional therapy, and the observation group was treated with mechanical ventilation on the basis of conventional therapy. The treatment effect in two groups was compared. Results Before treatment, both groups had no statistically significant difference in Glasgow coma score（GCS）, intracranial pressure（ICP）, arterial partial pressure of oxygen（PaO₂）, arterial partial pressure of carbon dioxide（PaCO₂）, arterial oxygen saturation（SaO₂）（P>0.05）. After 24 h of treatment, the observation group had better GCS score, ICP, PaO₂, PaCO₂ and SaO₂ than the control group, and the difference was statistically significant（P<0.05）. The observation group had higher excellent prognosis rate as 43.90% than 21.95% in the control group, and the difference was statistically significant（P<0.05）. Both groups had preoperative CT imaging performance of brainstem compression and disappearance of cisterna ambiens. After 1 d of reexamination, the CT of brain stem was relieved compared with that of before operation. The cisterna ambiens was slightly clearer than that of before operation. There was no significant difference between the two groups. After 1 week of reexamination of craniocerebral CT, the anoxia and edema of the brain tissue in the observation group were less than that of the control group, and the brain stem morphology was regular and the cisterna ambiens was clearer. Conclusion Application of mechanical ventilation for patients with severe craniocerebral injury shows important effect in improving all indicators and prognosis of patients, and can be promoted and applied in clinical practice.更多还原