经皮穿刺扩张气管切开术与传统气管切开术效果比较

Comparison between percutaneous dilatational tracheostomy and surgical conventional tracheostomy in clinical practice

目的观察经皮穿刺扩张气管切开术（PDT）的临床疗效。方法60例患者根据选取气管切开方式分为PDT组（30例）及传统气管切开术（SCT）组（30例）。比较两种气管切开方式在手术时间、术中及术后出血量、手术切口长度、切VI愈合时间以及皮下气肿、切口感染、低氧血症、气管食管瘘、纵隔气肿的发生率。结果PDT组手术时间（12．75±4．42）min，术中及术后出血量（12．23±10．10）ml，手术切口长度（1．48±0．12）cm。切口愈合时间（2．0±1．0）d；SCT组手术时间（29．60±8．14）min，术中及术后出血量（26．10±13．31）ml，手术切口长度（3．98±0．38）cm，切12I愈合时间（5．0±2．0）d；两组上述指标比较差异均有统计学意义（P均〈O．05）。PDT组皮下气肿、切口感染、纵隔气肿发生率均明显低于SCT组（P均〈O．05）。结论PDT出血量少、手术时间短、愈合快、术后疤痕小以及皮下气肿、切口感染、纵隔气肿发生率低。

Objective To discuss the difference between surgical conventional tracheostomy （SCT） and percutaneous dilatational tracheostomy （PDT）. Methods Thirty cases with SCT and 30 cases with PDT were selected, in whom the operation time, amount of blood loss, size of operative incision, incision healing time, infection rate, incidence rate of subcutaneous emphysema, incidence of mediastinal emphysema, incidence rate of hypoxemia, and incidence rate of tracheo-esophageal fistula were observed. Results The operation time was significantly shortened （（12.75±4.42） minutes vs. （29.60±8.14） minutes], blood loss was significantly decreased （（12.23 ±10. 10） ml vs. （26.10± 13.31） ml], size of operation incision was significantly shorter [（1.48 ±0.12） cm vs. （3.98 ±0.38） cm], incision healing time was significantly shorter [（2.0±1.0） days vs. （5.0±2.0） days3 in PDT compared with SCT （all P〈0.05）. PDT had less subcutaneous emphysema, infection and mediastinal emphysema in PDT than those in SCT （all P〈0.05）. Conclusion PDT is easier in performance, with less blood loss, shorter operation time, incision healing time and size of operation incision, lower infection rate, lower incidence of subcutaneous emphysema and mediastinal emphesema than SCT.