改良经皮扩张气管切开术在重症医学科危重患者中的应用研究  

Clinical application of modified Dercutaneous dilative tracheostomy in intensive care unit

作　　者：郜杨[1] 刘洋[1] 唐荣[1] 刘海涛[1] 张兴[1] 于凯江[1] 

机构地区：[1]哈尔滨医科大学附属第二医院重症医学科,黑龙江150086

出　　处：《中华危重病急救医学》2014年第2期106-109,共4页Chinese Critical Care Medicine

基　　金：黑龙江省教育厅科研基金资助项目（12531411）

摘　　要：目的探讨改良经皮扩张气管切开术（MPDT）在重症医学科重症患者中应用的临床价值。方法回顾性分析哈尔滨医科大学附属第二医院重症医学科143例行气管切开重症患者的临床资料，其中MPDT组55例，常规经皮扩张气管切开术（PDT）组41例，传统外科气管切开术（ST）组47例。比较3组手术操作时间、术中出血量等手术情况以及各种并发症的发生率。结果MPDT组与PDT组在手术时间（min：7．2±1．9、6．7±2．1）、术中出血量（mL：6．9±2．7、8．0±3．2）、切口长度（cm：1．2±1．1、1．3±0．9）以及切口愈合时间（d：7．5±2．0、6．7±1．9）等手术方面明显优于ST组（分别为23．1±4．5、26．3±3．8、2．8±1．2、10．1±2．1），差异均具有统计学意义（均P〈0．05）；但MPDT与PDT两组问差异无统计学意义。MPDT组与PDT组围手术期及远期并发症的发生率均明显低于ST组[围手术期：23．64％（13／55）、41．46％（17，41）比55．32％（26M7）；远期：18．18％（10／55）、31．71％（13／41）比55．32％（26／47）]，差异均有统计学意义（均P〈O．05）；且MPDT组未发生气管后壁损伤或穿孔及气管食管瘘，而PDT组分别有5例。结论MPDT是一种快速、创伤小、并发症少的微创气管切开术，可避免气管后壁损伤、穿孔及气管食管瘘的发生，值得在重症医学科推广廊用。Objective To investigate the application of modified percutaneous dilative tracheostomy （MPDT） in critical patients of intensive care unit （ICU）. Methods The clinical data of 143 critically ill patients experienced tracheostomy in intensive care unit （ICU） of the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. There were 55 cases in MPDT group, 41 in percutaneous dilative tracheostomy （PDT） group, and 47 in conventional surgical tracheostomy （ST） group. The operation information such as operation time, blood loss and the incidence of complications were observed among three groups. Results The operation time （minutes： 7.2 ± 1.9, 6.9 ± 2.1 ）, amount of blood loss （mL： 6.9 ± 2.7, 8.0 ± 3.2）, size of operative incision （era： 1.2 ± 1.1, 1.3 ± 0.9） and incision healing time （days： 7.5 ± 2.0, 6.7 ± 1.9） in MPDT group and PDT group were superior to ST group （23.1 ± 4.5, 26.3 ± 3.8, 2.8 ±1.2, 10.1 ± 2.1, respectively） with statistical signifieanees （all P〈O.05 ） but there was no significant difference in above indexes between MPDT group and PDT group. The incidences of perioperative and postoperative complications in MPDT group and PDT group were significantly lower than those in ST group [ perioperative period ： 23.64% （ 13/55 ）, 41.46% （ 17/41 ） vs. 55.32% （ 26/47 ） ; postoperative period ： 18.18% （ 10/55 ）, 31.71% （13/41） vs. 55.32% （26/47）] with statistical significances （all P〈0.05）. There was no tracheal wall injury or perforation and tracheoesophageal fistula in MPDT group, while there were 5 tracheal wall injuries, 5 perforations, and 5 tracheoesophageal fistulas in PDT group. Conclusion MPDT which is more effective, safe, simple and with minor injury than ST, is able to avoiding tracheal wall injury or perforation and traeheoesophageal fistula and is very suitable for patients in ICU.

关 键 词：改良经皮扩张气管切开术 并发症 重症医学科 

分 类 号：R655[医药卫生—外科学]