经皮气管切开在颈椎骨折合并呼吸障碍中的应用

Application of IPDT in cervical spine fracture complicated with respiratory dysfunction

目的探讨经皮气管切开(IPDT)在颈椎骨折并呼吸功能障碍患者救治中的应用价值。方法收集本院2003—2010年收治的39例颈椎骨折,使用传统气管切开术(ST)22例,使用IPDT 17例,比较两组术中一般情况及并发症情况。结果IPDT组在手术时间、出血量、切口大小及甲状腺误伤率方面明显优于ST组,差异具有统计学意义(P<0.05);IPDT组的皮下气肿、切口溢痰、气管狭窄、套管脱出的发生率均明显低于ST组,差异有统计学意义(P<0.05)。结论 经皮气管切开具有手术时间短、创伤小、出血量少、手术并发症发生率少等优点,且手术过程安全、可靠,在颈椎骨折合并呼吸功能障碍患者中可作为首选的气道开放的方法。

Objective To analyze the application value of improved percutaneous dilational tracheostomy（IPDT） in treatment of cervical spine fracture complicated with respiratory dysfunction.Methods 39 cases of cervical spine fracture in our hospital from 2003 to 2010 were selected.22 cases were treated with surgical tracheotomy（ST） and 17 cases were treated with IPDT.Ordinary condition and complications were compared between the 2 groups.Results The operation time,amount of bleeding,incision size and accidentally injure rate of thyroid gland in IPDT group were significantly better than that in ST group,the difference had statistical significance（P0.05）.The incidence rate of pneumoderma,overflow of phlegm,tracheostenosis and canula prolapsus in IPDT group were significantly lower than that in ST group,the difference had statistical significance（P0.05）.Conclusion IPDT has the advantages of short operation time,slight trauma,less bleeding and less complications.It is a safe and effective therapy and should be the first choice for air conduct opening in patients with cervical spine fracture complicated with respiratory dysfunction.