手术者经验对经皮扩张气管切开术影响的研究

The Influence of Operator's Experience on Percutaneous Dilatational Tracheostomy

目的:观察手术者经验的积累对经皮扩张气管切开术实施过程、并发症的影响。方法:对2006年6月-2008年12月入住我院ICU的经同一手术者进行经皮扩张气管切开术的24例患者进行研究,分析手术者在不同阶段经皮扩张气管切开术从局部麻醉到插入气管套管的时间、术中出血量、术后发生皮下气肿、气胸等并发症的发生率。结果:全部病例的手术时间为4～18min,平均手术时间为(8.25±3.94)min,术中出血量1～20ml不等,平均出血量为(5.08±4.89)ml,其中前10例的手术时间为(11.5±3.78)min,出血量为(7.2±7.0)ml,后14例的手术时间为(5.93±1.90)min,出血量为(3.57±1.55)ml;术后发生皮下气肿4例,其中3例发生于前10例;不同阶段比较差异具有统计学意义(P<0.05)。所有病例无1例发生气胸、大出血等严重并发症。结论:手术者对技术掌握的熟练程度对手术时间及术中出血、术后皮下气肿等并发症的发生具有明显影响,提示为减少术中、术后的并发症,缩短手术时间,加强对手术者的培训十分重要。

Objective：To observe the influence of operator＇s experience on the procedure and complication of percutaneous dilatational tracheostomy.Methods：24 patients who underwent PDT by same operator were investigated from June 2006 to December 2008 in our ICU department.Patients were divided into early and later period group.Operation time,volume of bleeding during operation,and subcutaneous emphysema,pneumothorax after PDT were analyzed.Results： Operation time in the early 10 patients was significantly longer than in the later 14 patients[（11.5±3.78）min vs（5.93±1.90）min,P0.05].Volume of bleeding during operation in the early patients was significantly more than in the later patients[（7.2±7.0）ml vs（3.57±1.55）ml,P0.05].Four subcutaneous emphysema occurred in all patients and three of them occurred in the early 10 patients.No severe complications such as pneumothorax and hemorrhage occurred.Conclusion：Experience of operator significantly influences the operation time,volume of bleeding during operation,and subcutaneous emphysema after PDT.It is important to train operator before performing PDT.