经皮扩张气管切开术在ICU急危重症患者中的价值  

Evaluation the value of percutaneous dilational tracheostomy in critically ill patients in ICU

作　　者：罗醒政[1] 王涛[1] 雷玲[1] 刘力新[1] 简志刚[1] 池锐彬[1] 

机构地区：[1]南方医科大学附属小榄医院重症医学科,广东中山528415

出　　处：《临床急诊杂志》2015年第2期112-114,117,共4页Journal of Clinical Emergency

摘　　要：目的:比较经皮扩张气管切开术(percutaneous dilational tracheostomy,PDT)与常规气管切开术(surgical tracheostomy,ST)在急危重患者的应用效果和并发症,评价PDT的临床价值。方法:选择2012-01-2014-04我院需气管切开的ICU患者,随机分成2组(PDT组与ST组),比较2组患者手术时间、切口长度、术中最低血氧饱和度、术中和术后3d出血以及术后7d切口感染的情况。结果:234例患者纳入研究并全部顺利完成手术。PDT组和ST组在平均手术时间、切口长度、术中最低血氧饱和度以及术中、术后出血情况方面差异无统计学意义。术后7d切口感染情况比较,PDT组轻度、中度及重度感染发生率为13.1%(16/122)、4.9%(6/122)、0.8%(1/122),ST组分别20.5%(23/112)、9.8%(11/112)、2.7%(3/112),差异有统计学意义(P<0.05)。ST组有1例发生皮下气肿,2组均无气胸、意外脱管、术中心跳停搏及术后食管气管瘘。结论:与ST比较,PDT具有手术时间短、手术切口小及术后感染风险小等优点,但在术中、术后出血差异无统计学意义。PDF操作简单、快捷、高效,适合于抢救困难插管而又需紧急开放气道的急危重症患者。Objective：To compare the effect and complication of percutaneous dilational tracheostomy（PDT）and surgical tracheostomy（ST）on intensive care unit（ICU）patients,evaluating the value of PDT.Method：From January 2012 to April 2014,234 ICU patients were randomized into PDT group and ST group.The surgical duration、cut length、minimal SPO2 during operation、bleeding volume during and three days after operation and incision infection 7days after operation was compared.Result：All operations were done successfully.There was no statistical difference between groups for the average operation time,incision length,the lowest oxygen saturation,and intraoperative or postoperative bleeding.In PDT group,the incidence of mild,moderate,and severe infection were13.1%（16/122）,4.9%（6/122）,0.8%（1/122）respectively.In ST group,the incidence of mild,moderate,and severe infection were 20.5%（23/112）,9.8%（11/112）,2.7%（3/112）.There was one subcutaneous emphysema case in ST group.No pneumothorax,accidental tube drop,cardiac arrest,and esophageal-tracheal fistula occurred in both groups.Conclusion：PDT has shorter surgical time、smaller incision and lower incidence of infection compared with ST.PDT can be performed simply,and has high value on patients who need open airway immediately but have difficulty on orotracheal intubation.

关 键 词：经皮扩张气管切开术 气管切开术 并发症 可冲洗气管切开套管 

分 类 号：R655.3[医药卫生—外科学]