经皮单步扩张气管切开术在ICU危重症患者中的应用  

Single step dilatational tracheostomy in critically ill patients in intensive care unit

作　　者：左祥荣 刘梅红 施景 曹权 郑崇明 王勇[1] 刘少华 阙军 徐鑫荣 

机构地区：[1]南京医科大学第一附属医院重症医学科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2013年第3期364-367,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏高校优势学科建设工程资助(JX10231801);江苏省科技基础设施建设计划(创新平台提升项目)(BM2011017)

摘　　要：目的:探讨经皮单步扩张气管切开术(single step dilatational tracheostomy,SSDT)在ICU危重症患者中的临床应用效果及安全性。方法:64例ICU危重症患者根据气管切开方式不同分为两组,SSDT组和传统外科气管切开术(surgicaltracheostomy,ST)组,观察两组患者气管切开手术时间、切口大小、出血量、术中生命体征波动情况、术后切口出血、皮下气肿/气胸、溢痰、感染、手术相关死亡等情况。结果:SSDT组在气管切开手术时间、切口长度、出血量、术中生命体征(血压、心率、脉搏氧饱和度)波动等方面均优于ST组,差异具有统计学意义(P均<0.05),术后切口出血、感染、皮下气肿等并发症SSDT组仅9.4%,而ST组发生率高达53.1%,两组相比有统计学意义(P<0.05)。结论:SSDT操作简单、快速,并发症少,安全性高,适合ICU需要气管切开的危重患者。Objective：To explore the application value of the single step dilatational tracheostomy （SSDT） in critically ill patients in the intensive care unit （ICU）. Methods：Consecutive sixty-four patients were randomly divided into SSDT group （32 cases） or traditional surgical tracheostomy （ST） group （32 cases）. The operation time,incision size,blood loss,changes of vital signs,and postoperative complications such as infection rate,incidence rate of subcutaneous emphysema/pneumothorax,infection rate,and procedure-related mortality were observed. Results： The operation time, amount of blood loss, size of operative incision and changes of vital signs in the SSDT group were superior to those in the ST group （P 〈 0.05）. While the rate of overall complications including wound bleeding,subcutaneous emphysema/pneumothorax,overflow and incision infection was lower in the SSDT group （9.4%） compared with the ST group （53.1%） （P 〈 0.05）. Conclusion： Compared with the ST, the SSDT is more effect, safe, and simple with less perioperative complications for critically ill patients.

关 键 词：气管切开术 经皮扩张气管切开术 ICU 并发症 

分 类 号：R653[医药卫生—外科学]