异常体位危重患者气管造口临床研究

Tracheostoma in critical patients with abnormal posture

目的对异常体位危重患者气管造口方法的选择进行评价。方法在不影响正常临床治疗的前提下，对采用不同气管造口方法的异常体位危重患者进行回顾性总结研究，将患者分为气管穿刺组（48例）和气管切开组（48例）。气管穿刺组采用经皮旋转穿刺气管造口方法，气管切开组采用传统手术气管切开方法。统计两组患者重要生命体征和医疗指标情况。结果气管穿刺造口术较传统的手术方法损伤小、操作方便、安全、快捷，对体位要求不高，两组患者气管造口时平均动脉压、心率、中心静脉压有显著差异（P〈0．01）。结论在危重患者处于异常体位时，选择经皮旋转穿刺气管造口方法明显优于传统手术气管切开方法，值得临床推广应用。

Objective To evaluate tracheostoma used in patients with abnormal posture. Methods A total of 96 critical patients admitted to our hospital from January 2005 to December 2010 were retrospectively analyzed. The patients all received normal clinical treatment and were divided into tracheal puncture group（48 cases with abnormal posture） and tracheotomy group（48 cases with normal posture）. Patients received percutaneous rotation trachea puncture in tracheal puncture group and traditional surgical tracheostomy in tracheotomy group. Vital signs and medical indices of patients in the two groups were assessed. Results Compared with tracheostomy, percutaneous rotation trachea puncture had no requirement for posture, which was safe and rapid with small damage and simple operation. Vital signs in tracheal puncture group, such as mean artery pressure（MAP）, heart rate（HR） and central venous pressure（CVP） were significantly lower than those in tracheotomy group[MAP： （90 ±12） vs （118 ± 10）mmHg; HR： （85 ±9） vs （106 ±12）/rain; CVP： （7 ±4） vs （9 ± 3）cmH2O; P 〈 0.01]. Conclusion In critical patients with abnormal posture, percutaneous rotation trachea puncture is obviously superior to traditional surgical tracheostomy and is well worth recommded clinically.