经皮微创气管切开置管在危重患者抢救中的应用

Application to critically ill patients with percutaneous minimal-invasive tracheotomy

目的进一步推广经皮微创气管切开置管救治危重患者的临床应用,探索其疗效、可行性及前景。方法收集经皮气管切开患者395例,占同期收治患者的46.8%,其中217例直接切开,178例由气管插管后再转行切开,全部采用Seldinger穿刺技术钢丝导引扩张置管法。结果395例无一例失败,242例病情好转后脱机并拔管转出ICU,有177例患者手术拔管后1～6个月随访无一例出现中心气道狭窄梗阻等并发症。结论经皮微创钢丝引导气管切开置管在危重患者抢救中具有快速、创伤性小、手术操作精确易掌握、成功率高、并发症少等优势,对提高危重患者抢救成功率有很大的前景。

Objective To discuss curative effect, feasibility and prospects of percutaneous minimal invasive tracheotomy for critically ill patients in order to popularize clinical application. Method 395 cases accounted for 46.8% of patients admitted into the hospital at the same period. 217 cases were done directly and 178 cases done after endotracheal intubation. All the patients accepted percutaneous minimal invasive wire - guiding dilating tracheotomy with the aid of Portex Equipment. Result All the 395 cases succeeded. To remove ventilators and drew catheters after 242 cases recovery, then the patients discharged from ICU. After the 6 - month follow - up, nobody had complications in the 177 cases. Conclusion Percutaneous minimal invasive wire - guiding dilating tracheotomy used to open airway and rescue critically ill patients is superior in short time, slight injury, high success rate, low complications.