超声筛查分类选择两种微创气管切开术在危重症患者中的应用研究  

The application research of two minimally invasive tracheotomy for ultrasound screening classification among critically ill patients

作　　者：曲伟 李霞 马丰庆 张洪兰 张晓涛 毕建耀 张凌云 QU Wei;LI Xia;MA Fengqing;ZHANG Honglan;ZHANG Xiaotao;Bi jianyao;ZHANG Linyun(Shidao people hospital,Rongcheng city,Shandong province,264308)

机构地区：[1]荣成市石岛人民医院,山东威海264308 [2]荣成市康宁医院,山东威海371082

出　　处：《中国急救复苏与灾害医学杂志》2020年第10期1236-1239,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的 采用超声筛查分类选择两种微创气管切开术,并与传统气管切开术相比较,探讨其在危重症患者中的应用价值.方法 选择2014年10月—2017年6月荣成市石岛人民医院110例有气管切开适应证患者,其中80例经超声筛查分为经皮下旋转扩张气管切开组和小切口微显露旋转扩张气管切开组,另30例采用传统气管切开术,将两个微创手术组与传统气管切开组患者资料相比较,观察手术相关情况及并发症发生情况.结果 经皮下旋转扩张组与传统气管切开组相比较,手术时间明显缩短,切口小,术中出血量明显减少,拔管后切口愈合时间缩短,瘢痕减小,差异具有统计学意义(P<0.01),套管一次性置入困难例数减少(P<0.05).小切口微显露旋转扩张组与传统气管切开组比较,切口明显减小(P<0.01),手术时间缩短,术中出血量少,拔管后切口愈合时间缩短,瘢痕减小(P<0.05).而经皮下旋转扩张组与小切口微显露旋转扩张组相比较,切口出血量明显减少(P<0.01),手术时间缩短(P<0.05).在术后并发症方面,两种微创气管切开组术后出血少,切口感染发生率低,气胸、皮下气肿、气管后壁损伤及气管食管瘘发生率低,分别与传统气管切开组相比较,总发生率均明显降低(P<0.01),而两种微创气管切开组组间比较差异无统计学意义(P>0.05).结论 采用超声筛查方案分类选择两种微创气管切开术,较传统气管切开术创伤小、手术时间短、出血量少、切口感染率低,能够大大提高手术安全性,同时减少并发症发生率.Objective Purpose By using the methods of two minimally invasive tracheotomy for ultrasound screening classification,in comparison with traditional tracheotomy,discuss its application value among critically ill patients.Methods Patient choose from 80 patinets of indications for tracheotomy of Shidao people hospital Rongcheng city,range from Oct.2014 to Jun.2017,patients had been classified into tracheotomy groups of percutaneous rotation dilation and tracheotomy groups of Small incision reveals rotating expansion,Compare data of two minimally invasive surgery groups and traditional tracheotomy group,having observation of surgery-related conditions and complications.Results As comparison of percutaneous rotation expansion group with traditional tracheotomy group,surgery operation time shorten significant、tiny incision、Intraoperative blood loss reduce evident,Incision healing time shorten after extubation,scar reduce,the difference shows statistically significant(P<0.01),difficulty cases of one-time insertion of cannula reduces(P<0.05).In comparison with traditional tracheotomy group,tracheotomy group of tiny incision rotating expansion shows that incision reduce significant(P<0.01),Operation time shortened,intraoperative blood loss reduced,the healing time of the extubation port incision shortened,scar reduce(P<0.05).Compare Rotating expansion group of subcutaneous immunotherapy with tiny incision reveal,bleeding volume of incision reduces significant(P<0.01),operation time shortened(P<0.05).In the aspects of postoperative complications,two minimally invasive tracheotomy groups reveals less postoperative bleeding,low infection incidence of incision,low infection of pneumothorax,subcutaneous emphysema,injury of the posterior trachea,and tracheoesophageal fistula,in comparison with traditional tracheotomy group,total incidence reduced significantly(P<0.01),the difference of two minimally invasive tracheotomy groups,however,shows no statistically significant(P>0.05).Conclusion By using the methods of two mi

关 键 词：超声筛查 微创 气管切开术 经皮扩张气管切开术 小切口 并发症 

分 类 号：R459.7[医药卫生—急诊医学]