三种气管切开术的临床应用比较

Clinical comparison of three types of tracheostomy

目的比较经皮气管切开术(Percutaneous tracheostomy,PT)、导丝扩张钳法气管切开术(Guide wire dilating forceps,GWDF)、经皮旋转气管切开术(PercuTwist)的手术时间和并发症的发生率,探讨三种气管切开术的安全性。方法收集2004年4月至2007年3月我院ICU施行的PT45例,GWDF38例,PercuTwist40例的病历资料分成A、B、C三组,计算每组出血、气胸、创口感染、脱管、气管后壁损伤的发生率和总发生率,采用SPSS13.0统计软件进行组间比较。结果A组的手术时间、出血的发生率和总发生率与B组和C组比较,P<0.05差异有统计学意义;气管后壁损伤的发生率B组、C组与A组比较,P<0.05差异有统计学意义;B组和C组并发症的发生率以及三组间气胸、创口感染、脱管的发生率比较无统计学意义。结论GWDF,PercuTwist操作简单、手术时间短、创伤小、并发症少,安全性优于PT,但有气管后壁损伤的危险。

Objective Comparing surgical time and the incidence rate of complications of Percutaneous tracheostomy （PT） and Guide wire dilating forceps （GWDF） and PercuTwist. To study their the safety. Methods we collected medical history data of have implemented PT 45 cases, GWDF 38 cases, PercuTwist 40 cases in ICU from April 2004 to March 2007. Then we divided them into A, B and C groups. Calculating per group＇s incidence rate of bleed, pneumothorax, wound infection, tube-off, hurting on endotracheal posterior wall and total incidence rate. Adopting the SPSS 13.0 statistics software to carry on comparison of two groups. Results Comparison between A group＇s surgical time, incidence rate of bleed, total incidence rate and other ones, P〈0.05, Difference have shown remarkable significance. Incidence rate of hurting on endotracheal postrior wall between B, C group and A group. P〈0.05, Difference have shown remarkable significance. Incidence rate of complications between B and C and Incidence rate of three groups of pneumothorax, wound infection, tube-off have no statistics meaning. Conclusions safety of GWDF and PercuTwist is better than PT. Operative process of GWDF or PercuTwist is simple. Surgical time is shorter than PT. The wound is smaller and the incidence rate of complications is lower. But it is possible that it would hurt endotracheal postrior wall.