改良经皮扩张气管切开术在气管插管患者中的应用

Clinical application of imprived modified percutaneous dilatational tracheostomy in intubated patients

目的探讨改良经皮扩张气管切开术(MPDT)在气管插管患者中的应用疗效及安全性。方法选择2014年1月至2015年12月在河北省邯郸市峰峰集团总医院治疗且行气管切开的149例患者,按随机数字分组的方法,将患者随机分为MPDT组(75例)及常规经皮扩张气管切开术(CPDT)组(74例),记录入选患者的年龄、性别、身高、体质量质数、入组时的APECHEⅡ及SOFA评分、手术时间、穿刺针数、术中出血量、手术并发症的发生率,组间比较采用t检验或χ~2检验。结果 MPDT组患者的手术时间[(9.27±4.28)min vs(13.09±3.93)min]、术中出血量[(8.32±6.35)ml vs(11.28±6.84)ml]均少于CPDT组,差异均有统计学意义(t=5.682、2.741,P均<0.05);MPDT组患者的穿刺针数略少于CPDT组[(1.19±0.39)针vs(1.38±0.70)针],一针穿刺成功率略高于CPDT组[84%(63/75)vs 73%(54/74)],但差异无统计学意义(P>0.05);MPDT组患者术后出血发生率较CPDT组低[0(0/75)vs 6.76%(5/74)],差异有统计学意义(χ~2=5.244,P<0.05);2组患者低氧血症、皮下气肿、气管食管瘘、假道发生率比较,差异均无统计学意义(P均>0.05)。术后并发症MPDT组低于CPDT组[5.3%(4/75)vs 13.5%(10/74)],但差异无统计学意义(P>0.05)。结论通过延迟拔管改良的经皮气管切开术操作简单,手术时间短、术中术后出血少,术后并发症少,值得临床推广使用。

Objective To assess the clinical application and safety of modified percutaneous dilatational tracheostomy （MPDT） in intubated patients. Methods Between January 2014 and December 2015, 149 consecutive patients were enrolled in this study .The patients were into two groups. In conventional percutaneous dilatational tracheostomy （CPDT） group （n=74）, PDT was performed with a conventional methed. In MPDT group （n=75）, PDT was performed with a modified method. The parameters of vital signs, age, sex, height, weight, the Acute Physiology and Chronic Health Evaluation II score （APACHE II ）, The sequential organ failure assessment （SOFA）, time during procedure ,times of puncturing, amount of bleeding and complications were recorded. Results There were no significant difference between the two groups in age, sex, APACHE II score and SOFA score （all P 〉 0.05）. Compared with CPDT group, both time during procedure [（9.27±4.28）min vs （13.09 ± 3.93）rain] and amount of bleeding [（8.32±6.35） vs （11.28±6.84） ml] during operation in MPDT group were less （all P 〉 0.05）. Times of puncturing [（1.19 ±0.39） vs （1.38 ± 0.70）] was fewer in trend, the first access success rate was 63 （84%） of 75 in MPDT group and 54 （73%） of 74 in the CPDT group, with no difference（P 〉 0.05）. Complications after operation were lower in MPDT group [5.3% （4/75） vs 13.5% （10/74）], but with no significant difference （P 〉 0.05）. Conclusions Compared to CPDT, MPDT by later extubation of endotracheal tube was much simple, consuming shorter operation time, with less bleeding during and after operation and causing fewer complications. These results support a widely application in intensive care units.