经皮扩张式气管切开在使用抗凝药物重症患者中的应用  

Percutaneous dialatational tracheostomy in critically ill patients taking anti-coagulant

作　　者：傅永鸿[1] 杨智[1] 苏伟[1] 陈伟明[1] 陈泳华 曾军[1] Fu Yonghong;Yang Zhi;Su Wei;Chen Weiming;Chen Yonghua;Zeng Jun(Department of Critical Care Medicine,Guangzhou First People’s Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院重症医学科,510180

出　　处：《国际医药卫生导报》2019年第11期1740-1743,共4页International Medicine and Health Guidance News

基　　金：广州市医药卫生科技项目(20161A010001).

摘　　要：目的 探讨经皮扩张式气管切开(PDT)在重症医学科使用抗凝药物患者中的安全性和可操作性。方法 患者在重症医学科纤维支气管镜辅助下床边实施PDT,从2015年3月至2017年3月,收集并分析使用和不使用抗凝药物患者的个人资料、临床资料、常规指标、临床结局和并发症等资料。结果 共有138位患者实施PDT,中位年龄72岁,体质指数(20.3±4.8)kg/m^2,APACHEⅡ评分(24.4±9.4)分,总体操作成功率为100%,手术操作时间为(25.0±8.5)min,围手术期没有致命性的并发症,使用抗凝药物及未使用抗凝药物组之间出血情况差异无统计学意义(P=0.657)。结论 在使用抗凝药物的患者中实施PDT是安全可行的,并不增加出血等并发症。Objective To explore the feasibility and safety of percutaneous dialatational tracheostomy(PDT)and bleeding complications in patients taking anticoagulant.Methods PDTs were performed by physicians by the ICU bedside using single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site.From March,2015 to March,2017,the patients’demographic and clinical data,procedural parameters,outcomes,and complications were analyzed and compared between the patients taking and not taking anticoagulants.The clinical data of 138 patients under PDT were retrospectively collected and analyzed.Results PDTs were performed in 138 patients;their median age was 72;their mean BMI(body mass index)was(20.3±4.8)kg/m2;and their mean acute physiology and chronic health evaluationⅡ(APACHEⅡ)score was(24.4±9.4).Overall,the procedural success rate was 100%and the procedural time was(25.0±8.5)min.There were no periprocedural life-threatening complications,and was no statistical difference in the incidence of bleeding complications between the patients who had taken anticoagulants and those had not(P=0.657).Conclusions PDT performed in critically ill patients taking anticoagulants is a feasible procedure and safe from bleeding complications.

关 键 词：气道管理 气管切开 重症医学科 抗凝药物 

分 类 号：R459.7[医药卫生—急诊医学]