初期行经皮扩张气管切开术常见问题与处理技巧探讨

Common Problems of Early Percutaneous Dilational Tracheostomy and Solutions to Them

目的探讨初期行经皮扩张气管切开术常见问题与处理技巧。方法采用Potex经皮穿刺气管套装,颈前正中线第2～3或第3～4气管软骨环间作穿刺点,行横向或纵向切口,采用导丝扩张技术,置入气管切开导管。结果 93例患者采用经皮扩张气管切开技术,术中及术后发生导丝折弯29例、切口过长8例、术后出血4例、皮下气肿3例、部位选择不当、置入气管旁及气管撕裂致颈部血肿各1例,其余经过顺利未发生严重并发症。结论经皮扩张气管切开术具有创伤小、手术操作简单、并发症少的优点,适合于ICU需床边建立人工气道的危重患者。

Objective To explore the common problems of early percutaneous dilational tracheostomy（PDT）and their solutions.Methods Potex PDT kit was used to make horizontal or vertical incisions into the midline between 2nd and 3rd or 3rd and 4th tracheal cartilaginous rings,and a tracheal canula was inserted in tracheal lumen by Guide Wire Dilating Forceps.Results A total of 93 patients underwent PDT.Guide wire was bended in 29 patients during or after operation,8 had too long incisions,4 had postoperative bleeding,3 subcutaneous emphysema,1 had inappropriate operative position and 1 had cervical hematoma caused by tracheal laceration.The rest had smooth operations without severe complications.Conclusion PDT,less invasive and easy with fewer complications,is suitable for critically ill patients who need bedside artificial airways in ICU.