经皮气管切开术与传统气管切开术在老年脑卒中患者救治中安全性的单中心随机对照研究  

Percutaneous Tracheostomy and Traditional Tracheotomy: A Single Center Randomized Controlled Study of Remedy Safety in Elderly Stroke Patients

作　　者：陈通[1] 付爱军[1] 朱军[1] 李建民[1] 肖增兵 宋向奇 何玉新[2] 李素花[2] 王瑞刚[1] 

机构地区：[1]河北联合大学附属医院神经外科,河北省唐山市063000 [2]河北联合大学附属医院曹妃甸区医院

出　　处：《中国全科医学》2014年第26期3060-3063,共4页Chinese General Practice

基　　金：唐山市科技局指令性课题(08130204A-1-12)

摘　　要：目的探讨经皮气管切开术(PDT)与传统气管切开术在老年脑卒中患者救治中的疗效及安全性。方法选择2011年6月—2013年6月在河北联合大学附属医院神经外科重症监护室住院的老年脑卒中患者143例,并按事先编好的号码将患者在微机中随机分入传统气管切开术(传统)组和PDT组。比较两种手术方法的操作时间、切口大小、术中出血量、切口愈合时间,术中大量出血(>100 ml)、术后皮下气肿、气胸、气管套管脱出、食管损伤、食管瘘、迟发性大出血(>100 ml)、气管软化塌陷、切口感染等并发症的发生率。结果术前传统组68例,PDT组75例,术后传统组排除和脱失43例,PDT组排除和脱失43例。两组患者的性别构成、年龄、发病到气管切开时间、术前格拉斯哥昏迷评分(GCS)、脑卒中类型分布情况比较,差异均无统计学意义(P>0.05)。两组患者均手术成功,PDT组手术操作时间、切口愈合时间均短于传统组,切口小于传统组,术中出血量少于传统组,差异有统计学意义(P<0.05)。传统组术中及术后并发症发生率为20.0%(5/25),PDT组为9.3%(3/32),差异无统计学意义(χ2=1.313,P>0.05)。结论 PDT相较于传统气管切开术能有效快速地建立老年脑卒中患者的气道,降低术中及术后并发症发生率,值得临床推广应用。Objective To study the curative effects and safety of percutaneous Dilational Tracheostomy（ PDT） and traditional tracheotomy in treatment of elderly stroke patients. Methods A total of 143 elderly stroke patients hospitalized in Affiliated Hospital of Hebei United University from June 2011 to June 2013 were divided randomly into groups traditional tracheotomy（ TT group,n =68）,PDT（ n =75）. The operating time,incision sizes,wound healing time,incidences of intraoperative massive bleeding（ 〉 100 ml）,post- operative subcutaneous emphysema,pneumothorax,tracheal tube prolapse,esophageal injury,esophageal fistula,delayed bleeding（ 〉 100 ml）,tracheomalacia,incision infection and other complications were compared.Results After operation,43 patients were excluded and lost in TT group,43 in PDT group. There was no significant difference in gender,age,time from onset to tracheotomy,pre- operative GCS scores,distribution of stroke types（ P 〉 0. 05）. Both groups had successful operations,the time of operation and healing was shorter,the sizes of incisions smaller,intraoperative bleeding amount less in PDT group than in TT group,the difference was significant（ P 〈 0. 05）. The incidence of intraoperative,postoperative complications was 20. 0%（ 5 /25） in TT group,9. 4%（ 3 /32） in PDT group,the difference was no significant（ χ2= 1. 313,P 〉 0. 05）. Conclusion Compared with traditional tracheotomy,PDT can create airway effectively and rapidly and reduce the incidence of intraoperative and postoperative complications in elderly stroke patients,which is worthy of clinical popularization and application.

关 键 词：气管切开术 卒中 老年人 随机对照试验 治疗 

分 类 号：R605.97[医药卫生—急诊医学] R743.3[医药卫生—外科学]