单腔深静脉穿刺包用于危重患者经皮扩张气管切开术的效果及安全性评价

Clinical Effect and Safety of Percutaneous Dilatational Tracheostomy with Single-chamber Deep Venous Catheter Package on Critically Ill Patients: A Comparative Study

目的评价采用单腔深静脉穿刺包实施经皮扩张气管切开术的效果及安全性。方法选取2010年1月—2012年11月我院重症医学科收治的采用常规气管切开包实施经皮扩张气管切开术的危重患者53例(对照组)及采用单腔深静脉穿刺包实施经皮扩张气管切开术的危重患者53例(试验组),比较两组患者的手术情况(手术时间、切口大小、术中出血量、误入假道、导丝弯折、手术费用)、围术期并发症(术后渗血量、支气管痉挛、皮下气肿、心律失常、气管后壁穿孔、纵隔气肿、甲状腺损伤)发生情况和远期并发症(吞咽障碍、切口感染、气管软化、气管-食管瘘、气管狭窄、套管脱出、瘢痕或肉芽形成)发生情况。结果 (1)两组患者手术时间、切口大小、术中出血量,误入假道、导丝弯折发生率比较,差异均无统计学意义(t=159.472,P>0.05);而试验组患者手术费用较对照组降低〔(465±22)元与(3 310±128)元〕,差异有统计学意义(P<0.01)。(2)两组患者术后渗血量及支气管痉挛、皮下气肿、心律失常、气管后壁穿孔、纵隔气肿、甲状腺损伤发生率比较,差异均无统计学意义(P>0.05)。(3)两组患者吞咽障碍、切口感染、气管软化、气管-食管瘘、气管狭窄、套管脱出、瘢痕或肉芽形成发生率比较,差异均无统计学意义(P>0.05)。结论与使用常规气管切开包作为经皮气管切开术材料比较,使用一次性单腔深静脉穿刺包作为经皮气管切开术的材料,同样具有微创、快速、并发症发生率低的特点,且其手术费用却较前者降低。

Objective To observe the clinical effect and safety of percutaneous dilatational tracheostomy（PDT） with single-chamber deep venous catheter package on critically ill patients.Methods 106 critically ill patients admitted to the Department of Intensive Care Medicine in our hospital from January 2010 to November 2012 were selected.Among the patients,the control group（53 cases） was given conventional PDT while the experiment group（53 cases） was given PDT with single-chamber deep venous catheter package.The operational situation（operation time,scar size,intra-operational blood loss,bending of the guide wire and costs）,the incidence of perioperative complications（post-operational blood loss,bronchospasm,subcutaneous emphysema,arrhythmia,the tracheal posterior wall perforation,pneumomediastinum and thyroid damage） and long term complications（postoperative swallowing dysfunction,wound infection,tracheomalacia,tracheo-esophageal fistula,tracheal stenosis,tube prolapsed and scar / granuloma formation） were compared with the two groups.Results（1） The operation time,scar size,intra-operational blood loss and the bending of the guide wire showed no statistically significant difference between the two groups（P《0.05）,but the cost of experiment group was significantly lower than the control group 〔（465 ± 22） yuan vs.（3 310 ± 128） yuan,t = 159.472,P《0.01〕.（2） The incidences of post-operational blood loss,bronchospasm,subcutaneous emphysema,arrhythmia,tracheal posterior wall perforation,pneumomediastinum and thyroid damage between the two groups showed no statistically significant difference（P《0.05）.（3） The postoperative swallowing dysfunction,wound infection,tracheomalacia,tracheo-esophageal fistula,tracheal stenosis,tube prolapsed and scar / granuloma formation between the two groups showed no statistically significant difference（P《0.05）.Conclusion Percutaneous dilatational tracheostomy with single-chamber deep venous catheter package is also minimally invasive,fast and has low incidence of perioperative complications and long-term complications,but the cost is more economical compared with conventional percutaneous dilatational tracheostomy pachage.