两种经皮气管切开术应用于心脏外科术后患者的临床效果比较

Two different methods for percutaneous dilational tracheostomy after cardiac surgery:a comparison of clinical outcomes

目的对比研究经皮导丝扩张钳技术(GWDF)和经皮单步扩张气管切开(SSDT)两种经皮气管切开术应用于心脏外科术后患者中的临床效果。方法选取2011年10月至2013年8月行正中开胸心脏手术术后符合气管切开指征的患者60例,分为GWDF组和SSDT组,每组各30例,对两组的手术时间、扩张次数、出血量和手术并发症等进行比较。结果 SSDT组操作时间明显短于GWDF组[(6.5±2.2)min vs(9.3±3.1)min,P=0.02],扩张次数明显少于GWDF组[(1.10±0.05)次vs(1.53±0.22)次,P=0.001],手术出血量明显少于GWDF组(P=0.000),总的严重并发症发生率明显低于GWDF组(P=0.000)。结论 SSDT与GWDF相比操作方便、手术时间短、创伤小、并发症少,可作为心脏术后危重患者气管切开的首选。

Objective To compare the clinical outcomes of two percutaneous tracheostomy methods,the guide wire dilating forceps(GWDF)and the single step dilational tracheostomy(SSDT),in patients having received cardiac surgery. Methods Totally 60 patients,who underwent mid-sternal thoracotomy from October 2011to August 2013 and had tracheostomy indications,were included in the present study.The patients were equally divided into GWDF group and SSDT group.The operation time,times of dilation,blood loss,and postoperative complications were compared between the two groups.Results The operation time of tracheostomy in the SSDT group was significantly shorter than that in the GWDF group([6.5±2.2]min vs[9.3±3.1]min,P=0.02).The times of dilation of the SSDT group was significantly less than that of the GWDF group(1.10±0.05vs 1.53±0.22,P=0.001);the blood loss was also significantly less than that of the GWDF group(P=0.000).The overall complication rate of the SSDT group was significantly lower than that of the GWDF group(P =0.000).Conclusion SSDT,compared to the GWDF,has the advantages of simple manipulation,short operation time,less trauma,and less complication,and it can be used as the first choice for severe patients after cardiac sugery.