老年人纤维支气管镜定位下经皮旋转扩张气管切开术

Use of endoscopic percutaneous dilatational tracheotomy in critical senile patients

目的探讨老年人在纤维支气管镜定位下经皮旋转扩张气管切开术在危重病中的应用价值。方法对2007年7月至2008年12月间收治我科行传统气管切开术（传统组42例，男41例，女1例）以及2009年1月至2011年6月间行纤维支气管镜定位下经皮旋转扩张气管切开术（PercuTwist组88例，男83例，女5例）的患者的临床资料进行了回顾性比较分析，比较两组手术操作时间、术中出血量、并发症发生率。结果传统组患者术前血小板最低值为55×10^9／L，平均手术时间为（30．744±5．06）min，出现并发症13例次。PercuTwist组患者术前血小板最低值为13×10^9／L，平均手术时间为（5．44±1．81）min，出现并发症6例次。PercuTwist组的手术时间和并发症发生率均显著低于传统组（P〈0．05）。结论经皮旋转扩张气管切开术是一种快速、出血量少、并发症少的微创气管切开术，适合重症监护病房危重病患者建立人工气道的要求。

Objective To discuss the application value of endoscopic percutaneous dilatational tracheotomy in critical senile patients. Methods The clinical data of patients from July 2007 to December 2008 who received surgical tracheostomy （conventional group, 42 cases, 41 males and one female ） and patients from January 2.009 to June 2011 who received endoscopic percutaneous dilatational tracheotomy （PercuTwist group, 88 cases, 83 males and five females）were retrospectively analyzed. The operation time, hemorrhagic in operation and complications were compared between two groups. Results In conventional group, the lowest platelet count was 55 × 10^9/L, the average operation time was （30.74 ±5.06） min and 13 cases experienced complications. In PercuTwist group, the lowest platelet count was 13 × 10^9/L, the average operation time was （5.44± 1.81 ） min and six cases experienced complications. The operation time and complications of PercuTwist group were significantly lower than conventional group （ P 〈0.05）. Conclusions Percutaneous dilatational tracheotomy is a minimally incision operation with shorter operation time, less bleeding and fewer complications. It can be used for critically ill patients who need to set up artificial trachea.