经皮扩张与传统气管切开术在气管切开患者中的应用效果对比(1)
[摘要] 目的 评价微创经皮扩张气管切开术(PDT)在ICU危重症患者中的应用价值。 方法 选取2005年5月～2014年8月行气管切开的患者384例，其中176例行PDT术，208例施行传统的开放式气管切开术(ST)，对比两组的手术时间、切口长度、术中出血量、切口愈合时间、瘢痕面积、围术期及后期并发症发生率、机械通气时间、住院天数、死亡率。 结果 PDT组的手术时间、愈合时间均短于对照组(P<0.01，P<0.05)，切口长度短于ST组，术中出血量少于ST组，瘢痕面积小于对照组(P<0.01)，两组的围术期、后期部分并发症发生率差异有统计学意义(P<0.05)，两组的机械通气时间、住院天数、死亡率差异无统计学意义(P>0.05)。 结论 PDT是一种简单微创的外科手术，适合在ICU开展。
[关键词] 经皮扩张气管切开术；开放式气管切开术；微创
[中图分类号] R767.91 [文献标识码] A [文章编号] 1674-4721(2015)02(a)-0018-03
Comparasion of application effect of percutaneous dilational tracheostomy and surgical tracheostomy on patients with tracheotomy
JIAN Yun-fei1 XING Xue-ning2
1.Department of Anesthesiology，People′s Hospital of Linhe District in Inner Mongolia Autonomous Region，Bayannaoer 015000，China；2.ICU，the First People′s Hospital of Yinchuan City，Yinchuan 750001，China
[Abstract] Objective To evaluate the application value of percutaneous dilational tracheostomy for critically ill patients in ICU. Methods 384 patients with tracheostomy were selected From May 2005 to August 2014，176 cases were given PDT operation，while 208 cases were given ST.Operation time，incision length，intraoperative blood loss，incision healing time，scar area，the incidence rate of perioperative and late complication，mechanical ventilation time，hospitalization day，the mortality in the two groups were compared. Results In the PDT group，operation time，incision healing time was shorter than that in the ST group (P<0.01，P<0.05)，incision length was shorter than that in the ST group，intraoperative blood loss were fewer than those in the ST group，scar area was smaller than that in the ST group (P<0.01)；there was no statistical difference of incidence rate of partial perioperative and late complication in the two groups (P<0.05)，there was no statistical difference of mechanical ventilation time after tracheostomy，hospitalization day and the mortality in the two groups (P>0.05). Conclusion PDT is a simple and minimally invasive surgery and it is suitable in ICU.
[Key words] Percutaneous dilational tracheostomy；Surgical tracheostomy；Minally invasive
ICU危重症患者常由于各种严重疾病可引起呼吸衰竭需要进行长时间的机械通气，而气管切开术是抢救此类患者的常用手术方法，可显著减少气道无效腔量，利于口腔和气道护理，便于气道管理[1]，但是其手术时间长、创伤大、并发症多等缺点也日益凸显，国外已报道其并发症发生率为6%～66%，死亡率为0%～5.3%[2]。经皮扩张气管切开术(percutaneou dilational tracheostomy，PDT)是近年来发展起来的一项微创外科技术[3]，最早是由Ciaglia等[4]在1985年首次报道，由于其操作简单、损伤小而在国内已逐步开展，银川市第一人民医院ICU自2005年就开展了此项技术，现将PDT与ST的对比研究做如下汇报。
1 资料与方法
1.1 一般资料
选取2005年5月～2014年8月银川市第一人民医院行气管切开的患者384例，分别是ICU所行的经皮扩张气管切开术(PDT)176例(男103例，女73例)，耳鼻喉科完成的传统的开放式气管切开术(ST)208例(男119例，女89例)，年龄分别为(51.0±14.3)、(52.4±15.1)岁，APACHEⅡ评分[5]为(20.3±4.2)、(19.5±3.7)分，凝血酶原时间(PT)为(13.1±2.1)、(12.3±1.9)s，部分凝血酶原时间(APTT)为(31.6±8.6)、(35.1±7.9)s，血小板(PLT)计数为(217.4±122.9)×109/L、(201.8±137.1)×109/L，两组的一般资料差异无统计学意义(P>0.05)，具有可比性。 (菅云飞 邢学宁)
[关键词] 经皮扩张气管切开术；开放式气管切开术；微创
[中图分类号] R767.91 [文献标识码] A [文章编号] 1674-4721(2015)02(a)-0018-03
Comparasion of application effect of percutaneous dilational tracheostomy and surgical tracheostomy on patients with tracheotomy
JIAN Yun-fei1 XING Xue-ning2
1.Department of Anesthesiology，People′s Hospital of Linhe District in Inner Mongolia Autonomous Region，Bayannaoer 015000，China；2.ICU，the First People′s Hospital of Yinchuan City，Yinchuan 750001，China
[Abstract] Objective To evaluate the application value of percutaneous dilational tracheostomy for critically ill patients in ICU. Methods 384 patients with tracheostomy were selected From May 2005 to August 2014，176 cases were given PDT operation，while 208 cases were given ST.Operation time，incision length，intraoperative blood loss，incision healing time，scar area，the incidence rate of perioperative and late complication，mechanical ventilation time，hospitalization day，the mortality in the two groups were compared. Results In the PDT group，operation time，incision healing time was shorter than that in the ST group (P<0.01，P<0.05)，incision length was shorter than that in the ST group，intraoperative blood loss were fewer than those in the ST group，scar area was smaller than that in the ST group (P<0.01)；there was no statistical difference of incidence rate of partial perioperative and late complication in the two groups (P<0.05)，there was no statistical difference of mechanical ventilation time after tracheostomy，hospitalization day and the mortality in the two groups (P>0.05). Conclusion PDT is a simple and minimally invasive surgery and it is suitable in ICU.
[Key words] Percutaneous dilational tracheostomy；Surgical tracheostomy；Minally invasive
ICU危重症患者常由于各种严重疾病可引起呼吸衰竭需要进行长时间的机械通气，而气管切开术是抢救此类患者的常用手术方法，可显著减少气道无效腔量，利于口腔和气道护理，便于气道管理[1]，但是其手术时间长、创伤大、并发症多等缺点也日益凸显，国外已报道其并发症发生率为6%～66%，死亡率为0%～5.3%[2]。经皮扩张气管切开术(percutaneou dilational tracheostomy，PDT)是近年来发展起来的一项微创外科技术[3]，最早是由Ciaglia等[4]在1985年首次报道，由于其操作简单、损伤小而在国内已逐步开展，银川市第一人民医院ICU自2005年就开展了此项技术，现将PDT与ST的对比研究做如下汇报。
1 资料与方法
1.1 一般资料
选取2005年5月～2014年8月银川市第一人民医院行气管切开的患者384例，分别是ICU所行的经皮扩张气管切开术(PDT)176例(男103例，女73例)，耳鼻喉科完成的传统的开放式气管切开术(ST)208例(男119例，女89例)，年龄分别为(51.0±14.3)、(52.4±15.1)岁，APACHEⅡ评分[5]为(20.3±4.2)、(19.5±3.7)分，凝血酶原时间(PT)为(13.1±2.1)、(12.3±1.9)s，部分凝血酶原时间(APTT)为(31.6±8.6)、(35.1±7.9)s，血小板(PLT)计数为(217.4±122.9)×109/L、(201.8±137.1)×109/L，两组的一般资料差异无统计学意义(P>0.05)，具有可比性。 (菅云飞 邢学宁)