经皮旋转扩张气管切开术与常规气管切开术在头颈部烧伤患者中的应用比较

Study clinical application of percutaneous dilational tracheostomy and surgical tracheostomy to the emergency patients with head and neck burn

目的观察经皮旋转扩张气管切开术（percutaneous dilational tracheostomy，PDT）与常规气管切开术（surgical tracheostomy，ST）在头颈部烧伤合并吸入性损伤急救中的临床疗效和并发症。方法回顾性分析头颈部烧伤合并中、重度吸入性损伤患者60例，按知情同意原则等分成ST组和PDT组。观察并比较两组患者手术时间、切口大小、术中出血、切口愈合时间和术后并发症等情况。结果气管切开后30min两组患者动脉血氧分压（PaO：）较术前30min均明显增加，但PDT组呼吸和心率变化小于ST组（P〈0．05）；PDT组手术时间[（9．61±2．42）min]较ST组[（23．26±2．93）min]明显减少（P=0．027），切口长度[（2．38±0．48）cm]较ST组[（5．99±1．15）cm]明显缩短（P=0．018），术中出血[（8．04±2．85）mL]较ST组[（23．89±4．27）mL]明显减小（P：0．01），切口愈合时间[（2．92±1．08）d]较ST组[（6．36±1．89）d]明显缩短（P=0．001）；PDT组术后脱管、感染、并发症发生率明显小于ST组（P〈0．05）。结论经皮旋转扩张气管切开术操作快速、损伤小、愈合快，且并发症发生率低，值得在头颈部烧伤合并吸人性损伤急救中推广应用。

Objective To explore the clinical application and complications of pereutaneous dilational tracheostomy（PDT） and surgical tracheotomy （ST） in the emergency treatment of head and neck burn. Methods To retrospectively analyze 60 patients with head and neck burn and inhalation injury. All the patients needed tracheotomy were divided into two groups： ST group and PDT group. The operation time, incision size, bleeding volume, incision healing time and postoperative complications were observed. Results PaO2 in PDT group and ST group was higher at 30 min after tracheotomy than those at 30 min before tracheotomy, the changes of respiration rate and heart rate in PDT group was smaller compared with ST group （ P 〈 0.05 ）. The operating hours in PDT group was shorter compared with ST group [ （9.61 ± 2.42 ） rain vs （ 23.26± 2.93 ） min, P = 0. 027 ] ; The length of incision in PDT group was shorter compared with ST group [ （2.38 ±0.48）cm vs （5.99 ± 1.15）cm, P =0. 018] ; Bleeding volume of operation in PDT group decreased compared with ST group [ （ 8.04± 2.85 ） mL vs （23.89 ±4.27）mL, P = 0.0t ]; Incision healing time in PDT group was shorter compared with ST group [ （2.92± 1.08） d vs （6.36 ± 1.89） d, P =0.001 ]. The rate of complications in PDT group was lower compared with ST group （ P 〈 0.05 ）. Conclusion Percutaneous dilational tracheostomy is a fast, little damage and the low incidence of complications, and is very suitable for the application in the emergency treatment of head and neck burn.