经皮扩张气管切开术在重症脑血管意外患者抢救中的应用价值

Study on the application value of percutaneous dilational tracheostomy on the rescue of patients with severe cerebrovascular accident

目的探讨经皮扩张气管切开术在重症脑血管意外患者抢救中的应用价值。方法选择2013年6月-2015年12月在我院接受抢救的重症脑血管意外患者为研究对象，根据其气管切开方式分为经皮扩张气管切开术组（PDT组，50例）和传统开放式气管切开术组（OT组，55例）。观察两组患者手术一般情况、抢救前后NIHSS评分、血气生化指标的变化及术后并发症发生率的差异。结果PDT组手术时间和愈合时间较OT组短，切口大小较OT组小，术中出血量较0T组少，差异有统计学意义（P〈0．01）；抢救前两组患者的NIHSS评分差异无统计学意义（P〉0．05），抢救后，两组患者的NIHSS得分较抢救前降低（P〈0．01），且PDT组降低更明显（P〈0．01）；抢救前两组患者的血氧饱和度（SpO2）、二氧化碳结合力（PCO2）等血气指标和乳酸、丙氨酸氨基转移酶（ALT）、尿素氮（Bun）等生化指标无明显差异，抢救后，两组患者的SpO2和pH均升高，而PCO2、乳酸、ALT、BUN和血肌酐（Scr）水平均有所下降（P〈0．05），且PDT组上述指标的变化更为明显（P〈0．05）；PDT组患者术后出血、皮下气肿发生率明显低于OT组（P〈0．05），两组患者切口感染、套管脱出和食管损伤的发生率差异无统计学意义（P〉0．05）。结论PDT可明显降低气管切开并发症的发生率，具有较好的临床应用价值。

Objective To explore the application value of percutaneous dilational tracheostomy （PDT）on me rescue of patients with severe cerebrovascular accident.Methods Patients with severe cerebrovascular accident treated in our hospital from June 2013 to December 2015 were selected as the research object.According to the way of tracheotomy,they were divided into percutaneous dilational tracheostomy （PDT group,50 cases） and conventional open tracheotomy group （OT group,55 case）.The common conditions,NIHSS score before and after treatment,blood gas and biochemical indicators and the postoperative complications in the two groups were compared.Results The operation time and healing time of PDT group were shorter than those of OT group,the size of incision was smaller than that of OT group, and the amount of intraoperative bleeding was less than that of OT group,with statistical difference （P〈0.01）.There was no sig- nificant difference in NIHSS scores between the two groups before treatment （P〉0.05）.While after the rescue,the NIHSS scores of the two groups were lower than those before treatment （P〈0.01）,and the PDT group decreased more significantly （P〈0.01）.After rescue,the levels of SpO2 and pH of the two groups were increased,and the levels of PCO2,1actate,ALT, BUN and Scr were all decreased,which were more obvious in PDT group （P〈0.05）.The incidence rate of postoperative bleeding,subcutaneous emphysema in PDT group was significantly lower than those in OT group （P〈0.05）.But there was no significant difference in the incidence rate of incision infection,tube prolapse and esophageal injury of the two groups （P〉0.05）.Conclusion PDT can significantly reduce the incidence of complications of tracheotomy,and has good clinical value.