经皮扩张气管切开导管在重症监护病房气胸患者胸腔闭式引流中应用的疗效观察  

Observation of the use of percutaneous tracheostomy tube for closed drainage of pneumothorax in intensive care unit

作　　者：亢宏山[1] 白艳 马洪芳[1] 杜智勇[1] 马珍[1] 王会青[1] 刘亚晶[1] 刘淑红[1] 崔朝勃[1] 

机构地区：[1]河北医科大学附属衡水市哈励逊国际和平医院重症医学科,053000 [2]衡水市妇幼医院,河北053000

出　　处：《中华危重病急救医学》2014年第12期901-904,共4页Chinese Critical Care Medicine

基　　金：基金项目：河北省衡水市科研与发展计划项目（12014A）

摘　　要：目的 探讨采用经皮扩张气管切开导管行胸腔闭式引流术在气胸抢救中的临床价值。方法 采用前瞻性随机对照研究方法，选择2010年6月至2014年6月河北医科大学附属衡水市哈励逊国际和平医院重症医学科收治的气胸患者32例，按随机数字表法分为对照组和观察组，每组16例。在治疗原发病的同时，对照组采用传统硅胶管行胸腔闭式引流，由胸科医师完成；观察组应用经皮扩张气管切开导管行胸腔闭式引流，由重症医师独立完成。观察两组患者的治疗效果及并发症发生情况。结果 与对照组比较，观察组从确诊气胸到手术完成时间明显缩短（min：8.00±1.36比23.06±3.83，t＝14.790，P＝0.000）；留管时间明显缩短（d：5.37±1.02比7.31±1.70，t＝7.286，P＝0.000）；住院期间引流管调整次数明显减少（次：0.18±0.40比3.87±1.14，t＝12.128，P＝0.000）；胸部X线检查次数明显减少（次：1.12±0.34比2.93±0.77，t＝8.589， P＝0.000）；住院时间明显缩短（d：8.30±1.37比24.56±5.62，t＝17.289，P＝0.000）；引流管脱出（0比3例）、引流管堵塞（0比5例）、皮下气肿（3比16例）等并发症发生例数明显减少，而切口感染（1比3例）、胸腔内感染（0比2例）发生情况无明显差异。结论 应用经皮扩张气管切开导管行胸腔闭式引流治疗气胸安全、简便，能够由重症医师独立完成，且并发症较少，疗效肯定。Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation（minutes：8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000）and the operation time were significantly shortened（days：5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000）,the frequency of drainage tube replacement（times：0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000）and the times of repeated chest radiography（times：1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000）in observation group were significantly reduced,the length of hospital day was significantly shortened（days：8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000）,the rates of dislocation of drainage tube（0 vs. 3 cases）,obstruction of the tube（0 vs. 5 cases）,and subcutaneous emphysema（3 vs. 16 cases）were reduced obviously,but there was no difference in incidence of incision infection（1 vs. 3 cases）and infection of thoracic cavity（0 vs. 2 cases）. Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.

关 键 词：经皮扩张气管切开导管 胸腔闭式引流 重症监护病房 

分 类 号：R459.7[医药卫生—急诊医学]