经皮穿刺气管切开术在紧急抢救中的应用价值

Value of application of percutaneous dilational tracheostomy in emergency patients

目的:比较经皮穿刺气管切开术(PDT)与传统开放式气管切开术(OT)在手术操作和并发症上的差异,探讨其在危重患者紧急抢救中的应用价值。方法:30例急诊拟行气管切开术的患者,随机分为两组。OT组15例行传统气管切开术,PDT组15例行经皮穿刺气管切开术,记录并比较两组患者的手术时间、切口大小、术中出血量及术后并发症、心率、血压和氧饱和度的变化。结果:PDT组手术时间、切口大小、术中出血、术后并发症发生率均明显低于OT组,术后1 h心率和收缩压也明显低于OT组(P均<0.05),但两组术后1 h的平均动脉压和血氧饱和度之间差异无显著性(P>0.05)。结论:与传统气管切开术比较,经皮穿刺气管切开术具有手术时间短、切口小、出血量少、并发症少等优点,适合在紧急抢救中应用。

Objective： To evaluate the value of percutaneous dilatational tracheostomy （PDT） and open tracheostomy （OT） in critical patients. Methods： In emergency, 30 consecutive adult patients in whom tracheostomy was necessary were randomly divided into two groups： patients in the percutaneous dilatational tracheostomy （PDT） group （n： 15） received PDT, and patients in the open tracheostomy （OT） group （n = 15） received OT. The duration for the operation,the size of the incision,the volume of blood loss during the operation, the incidence of complications and the changes in the heart rate, blood pressure, oxygen saturation were compared between the two groups. Results： Generally PDT procedure was completed in 2-15 minutes. The time span for the operation was then shorter, the size of the incision, the volume of blood loss, the incidence of complications were lower, and the heart rate and the systolic pressure 1 hour after the operation were lower in the PDT group than those of the OT group （P〈 0. 05）. There was no significant difference in the mean arterial pressure and blood oxygen saturation 1 hour after operation between the two groups （P〉0. 05）. Conclusions： PDT is more suitable for critically ill patients than OT with its advantages of shorter operation time, smaller incision, less loss of blood, and fewer complications.