经皮牛角扩张气管切开术在综合性ICU应用的回顾性分析  

Retrospective analysis of percutaneous tracheostomy horns expansion application in General Intensive Care Unit

作　　者：盛鹰[1] 王树云[1] 王静恩[1] 谢晓洪[1] 蔡金芳[1] 高波[1] 朱念[1] 

机构地区：[1]上海市浦东医院复旦大学附属浦东医院重症医学科,上海201399

出　　处：《临床急诊杂志》2016年第9期659-662,667,共5页Journal of Clinical Emergency

基　　金：复旦大学附属浦东医院"浦秀"培养计划资助(No:PX201304)

摘　　要：目的:评价经皮牛角扩张气管切开术在综合性重症监护病房(ICU)的应用价值。方法:回顾性分析我院ICU 6年间320例行气管切开术患者的临床资料,其中2013-03-2016-02行经皮牛角扩张气管切开术(PDT)的168例患者作为PDT组,2010-03-2013-02收治并行传统外科气管切开术(TST)的152例患者作为TST组。比较2组手术时间、切口长度、术中出血量、拔管后切口愈合时间,以及围手术期及远期并发症的发生率。结果:1与TST组相比,PDT组手术时间、切口长度、术中出血量、拔管后切口愈合时间均明显减少,差异有统计学意义[(8.8±2.4)min vs.(20.3±2.8)min,(1.2±0.3)cm vs.(4.2±0.3)cm,(5.2±1.2)ml vs.(9.9±2.3)ml,(4.8±1.8)d vs.(8.9±2.9)d;P<0.01];2PDT组围手术期并发症总发生率为8.3%,远低于TST组的28.9%(P<0.01),心率失常为2组中最常见的并发症,切口大出血、心率失常、术中低氧合3个发生率比较差异有统计学意义(1.8%vs.6.6%,2.4%vs.7.9%,1.8%vs.6.6%;均P<0.05);远期并发症气管食管瘘及气管狭窄的发生率PDT组均低于TST组,差异有统计学意义(0.6%vs.3.9%,P=0.0406;1.2%vs.7.6%,P=0.003 4)。结论:与TST相比,应用牛角型扩张技术行PDT优势明显,值得在ICU推广应用,今后仍旧需要对提高PDT安全性,降低并发症方面进行积极探索。Objective：To evaluate the application value of percutaneous tracheostomy horns expansion in General Intensive Care Unit.Method：The clinical data of 320 patients with tracheostomy in intensive care unit（ICU）of the Shanghai Pudong Hospital in recent six years were retrospectively analyzed.There were 168 cases divided into peutaneous dilational tracheostomy（PDT）group who received the Ciaglia Blue Rhino method from the March2013 to February 2016,and 152 cases divided into traditional surgical tracheostomy（TST）group who received TST from the March 2010 to February 2013.The procedural time,the length of the incision,intraoperative blood loss,and the perioperative and long-term complications were analyzed.Result：1Compared with TST group,the procedural time,the length of the incision,the amount of intraoperative blood loss and the incision healing time were lower significantly in PDT group[（8.8±2.4）min vs.（20.3±2.8）min,（1.2±0.3）cm vs.（4.2±0.3）cm,（5.2±1.2）ml vs.（9.9±2.3）ml,（4.8±1.8）d vs.（8.9±2.9）d;P〈0.01];2The total incidence of perioperative complications in PDT group was lower significantly than that in TST group（8.3% vs.28.9%,P〈0.01）.Arrhythmia was the most common complication in two groups.Bleeding（〉100ml）,arrhythmia and hypoxemia were significantly lower in PDT group（1.8% vs.6.6%,2.4% vs.7.9%,1.8% vs.6.6%,P〈0.05）.Compared with TST group,the incidence of long-term complications including tracheoesophageal fistula and tracheal stenosis were lower significantly in PDT group（0.6% vs.3.9%,P=0.0406;1.2% vs.7.6%,P=0.0034）.Conclusion：PDT with the Ciaglia Blue Rhino method is worth to be applied in ICU patients,which is superior to TST.We still need to pay more attention to the safety and complications of PDT in future.

关 键 词：经皮扩张气管切开术 牛角型扩张法 重症医学科 

分 类 号：R653[医药卫生—外科学]