低位气管切开术在呼吸机辅助呼吸患者中的临床应用

Clinical application of low tracheotomy in patients with ventilator-assisted breathing

目的分析低位气管切开术在呼吸机辅助呼吸患者中的应用价值。方法将2010年3月～2012年12月期间216例需机械通气的ICU危重患者随机分为低位气管切开术(low tracheotomy,LT)组(Ⅰ组)及常规气管切开术(surgical tracheostomy,ST)组(Ⅱ组),观察比较两组手术时间、切口长度、术中出血量、多种并发症发生率和拔管后愈合时间。结果Ⅰ组的手术时间、切口长度、术中出血量、切口愈合时间均明显小于ST组(P<0.05);Ⅰ组的皮下气肿、切口出血、切口感染、脱管的并发症发生率均明显低于Ⅱ组(P<0.05);两组术中低氧血症、术后拔管困难发生率比较均无明显差异(P>0.05)。结论低位气管切开术是一种安全、快速、创伤少、并发症少的气管切开方式,特别适合呼吸机辅助呼吸患者床边采用。

Objective To analyze low tracheotomy application value of patients with ventilator-assisted breathing. Methods During the period from 2010 March to 2012 December, 216 patients with mechanical ventilation in ICU critically were randomly divided into low tracheotomy （low tracheotomy, LT） group （group I ） and conventional tra- cheotomy （surgical tracheotomy, ST） group （group 11 ）. The two groups were observed and compared from operation time, incision size, the amount of bleeding, multiple complications and extubation time of healing. Results The oper- ation time of I group, the length of incision, the bleeding and the recovery time is shorter than the II group （P〈 0.05） ;The complication of the subcutaneous emphysema, incision bleeding, incision infection and disconnection is lower than the [I group （P〈0.05） ; The difficulty happening rates of hypoxemia and tracheal extubation from these two group are not significant difference（P〉0.05）. Conclusion low tracheotomy is a safe, fast, less trauma, less complica- tions of tracheotomy, especially suitable for mechanical ventilation patients at the bedside.