经皮穿刺导丝牛角扩张气管造口术在ICU急危重患者中的应用

Application of percutaneous dilational tracheotomy-guide wire cattle horn for acute and critical patients in ICU

目的比较经皮穿刺导丝牛角扩张法气管造口术(PDT-GWCH)与常规气管切开造口术(surgical tracheostomy ST)急危重患者的应用效果和并发症方面的差异,探讨PDT-GWCH在ICU危重病人患者中的临床应用价值。方法将本院2012年1月-2017年03月ICU病房收治的、需要机械通气并有气管切开适应症的50例危重症患者随机分成:PDT-GWCH组(PDT组,n=25例)和ST组(n=25例)。比较2组患者手术时间、切口长度、术中出血和术后出血以及术后溢痰、切口感染的情况。结果 50例患者纳入研究并全部顺利完成手术。PDT-GWCH组和ST组在平均手术时间、切口长度、术中出血、术后出血以及术后溢痰、切口感染的比较,差异有统计学意义(P<0.05)。ST组有1例发生气胸、纵隔气肿,2例发生皮下气肿,2组均无气管塌陷及气管食管瘘。结论与ST比较,PDT-GWCH具有手术时间短、手术切口小、术中、术后出血少及术后溢痰少、感染风险小等优点,差异有统计学意义。适合于需开放气道的ICU急危重症患者。

Objective To compare the application value and complications between percutaneous dilational tracheotomy-guide wire cattle horn （PDT-GWCH） and surgical tracheostomy （ ST） for acute and critical patients in ICU. Methods 50 urgent critically ill patients with mechanical ventilation and tracheotomy indications admitted to our hospital from January 2012 to March 2017 were randomly divided into the PDT-GWCH group （the PDT group, n =25 cases） and the ST group （ n =25 cases） . Their operative time, incision length, bleeding and postoperative bleeding, as well as postoperative sputum infection and wound infection were compared between the two groups. Re-sults 50 patients were included in the study and all were successfully completed. There were significant differences in mean operative time, incision length, intraoperative bleeding, postoperative bleeding, postoperative sputum infec-tion and incision infection between the PDT-GWCH group and the ST group （P 〈0. 05）. In the ST group, there was 1 case of pneumothorax and mediastinal emphysema and 2 cases of subcutaneous emphysema. There was no tracheal collapse and tracheal esophageal fistula occurred in the two groups. Conclusion Compared with ST, PDT-GWCH has the advantages of short operative time, small incision, less intraoperative and postoperative bleeding, less risk of postoperative sputum infection and incision infection and so on with statistical significance, which is suitable for the urgent critically ill patients in ICU needing to open airway