经皮气管切开术在多发伤救治中的应用研究

The research of application of the percutaneous tracheostomy in the treatment of patients with multiple injuries

目的:探讨经皮气管切开术在多发伤救治中的应用价值。方法:回顾性分析2012-12-2014-12我院创伤外科行气管切开的多发伤患者128例,将其分为传统气管切开组(传统气切组)和经皮气管切开组(经皮气切组),对比2组患者手术完成情况、易操作性、术中出血量、操作时间、术后并发症发生率、感染菌种构成、机械通气时间、ICU时间、切口愈合时间及住院时间等指标。结果:2组患者年龄、性别构成、致伤因素、格拉斯哥昏迷评分(GCS)、伤后切开时间、术后机械通气时间和住院时间比较,差异均无统计学意义(P>0.05),而经皮气切组患者损伤严重程度评分(ISS)高于传统气切组(P<0.05),且ICU时间及切口愈合时间均短于传统气切组(P<0.05,P<0.01);实施2组患者手术的医师对经皮气切组手术易操作、出血少的评价优于传统气切组(94.1%vs.5.9%,91.2%vs.8.8%),且低年资医师经皮气切组手术独自完成率高于传统气切组(84.9%vs.66.7%,P<0.05),经皮气切组手术操作时间和出血使用纱布数均明显少于传统气切组(P<0.01);2组患者总的并发症比较差异无统计学意义(P>0.05),而在伤后72h内行气管切开患者中,经皮气切组并发症发生率低于传统气切组(P<0.05),2组伤后72h外行气管切开患者的并发症发生率比较,差异无统计学意义(P>0.05);经皮气切组总的病死率低于传统气切组(P<0.05);术后2组患者痰培养感染菌种构成比差异无统计学意义(P>0.05)。结论:经皮气管切开术易于培训操作,出血量少,且操作时间短,早期实施并发症少,病死率低,安全性优于传统气管切开术,在多发伤救治中有良好的应用效果。

Objective：To explore the application value of the percutaneous tracheostomy in the treatment of patients with multiple injuries.Method：Clinical data of 128 cases of multiple injuries suffered tracheotomy was analyzed retrospectively from December 2012 to December 2014 in trauma surgical department.All cases were divided into 2groups：the percutaneous tracheostomy group and the traditional tracheostomy group.The situation of surgery completion,easy operability of surgery,intraoperative bleeding amount,operating time,incidence of postoperative complications,bacteria type of infection,postoperative mechanical ventilation time,ICU time,wound healing time and hospital staying time,etc,were compared.Result：There was no statistically significant difference in gender,age composition,injury factors,GCS score,tracheostomy time after injury,the duration of mechanical ventilation,length of staying in hospital between two groups（P〈0.05）.Percutaneous tracheostomy group had higher ISS scores than traditional tracheostomy group（P〈0.05）,and the ICU time and wound healing time in percutaneous tracheostomy group were both shorter than that of traditional tracheostomy group（P〈0.05,P〈0.01）.Easy operability and less bleeding of percutaneous tracheostomy were better than traditional tracheostomy（94.1% vs.5.9% and 91.2% vs.8.8%）,which were evaluated by doctors who have implemented over the two type surgery.The junior doctors had a higher independent completion rate（84.9% vs.66.7%,P〈0.05）in percutaneous tracheostomy group.Average operating time and the number of used gauzes for bleeding during operation of percutaneous tracheostomy group were significantly less than those of traditional tracheostomy group（P〈0.01）.There was no statistically significant difference between two groups about all postoperative complications（P〉0.05）.But percutaneous tracheostomy had lower incidence of complications（P〈0.05）,if tracheostomy had been operated within 72 hours after injury.Otherwise the incidence has no statistically significant difference（P〈0.05）.Percutaneous tracheostomy group had a lower mortality rate than traditional tracheostomy group（P〈0.05）.The result of sputum culture of postoperative infections in two groups showed that the constitution of bacterial has no statistically,significant difference（P〈0.05）.Conclusion：Percutaneous tracheostomy is easy to be trained and operated.In addition,it has less bleeding,shorter operating time,fewer complications when early implementation,lower mortality rate,higher safery than traditional tracheostomy.So percutaneous tracheostomy has a good effect in the treatment of multiple injuries.