介绍一种改良经皮扩张气管切开术

Comparative study for application effect of percutaneous dilational tracheostomy in the treatment of critically ill patients

目的 介绍一种新的改良经皮扩张气管切开术（PDT）并观察比较PDT改良前后在危重症患者中的应用效果.方法 收集2016年1月至2017年1月重症医学科（ICU）行PDT的120例患者的临床资料,分别为常规PDT术组60例和改良PDT术组60例,对两组患者的性别、年龄、体质量、体质量指数（BMI）、APACHEⅡ评分等一般情况和两组患者手术所需时间、手术切口大小、术中出血量、拔除气管套管后切口愈合时间以及手术后并发症的发生率进行比较.结果 两组患者在性别、年龄、体质量、体质量指数（BMI）、APACHEⅡ评分等指标方面差异无统计学意义（P〉0.05）;与常规PDT术组相比较,改良PDT术组手术时间、术中出血量、切口大小明显减少[（5.80±1.19）min比（7.65±1.05）min、（8.33±3.30）ml比（11.33±4.34）ml、（1.08±0.30）cm比（1.27±0.25）cm]（P〈0.05）,差异有统计学意义,但两组患者的切口愈合时间比较差异无统计学意义（P〉0.05）;两组并发症的发生率比较差异无统计学意义（P〉0.05）.结论 与常规PDT相比较,改良PDT减少手术时间和术中出血量,手术切口小,值得广泛推广应用.

Objective To introduce a new modified percutaneous dilational tracheostomy and compare the application effect of percutaneous dilational tracheostomy with modified percutaneous dilational tracheostomy in the treatment of critically ill patients. Methods A total of 60 critically ill patients undergoing tracheotomy were selected , and they were randomly divided into two groups according to the methods of tracheotomy. Sex, age, weight, body mass index, acute physiology and chronic health evaluation, operation time, incision size, intraoperative blood loss, incision healing time, incidences of complications after operation were compared between the two groups. Results There were not statistically significant differences of in sex, age, weight, body mass index, and acute physiology and chronic health evaluation between percutaneous dilational tracheostomy group and modified percutaneous dilational tracheostomy group （P〉0.05）. Operation time, incision size and intraoperative blood loss of modified percutaneous dilational tracheostomy group was statistically significantly shorter than that of percutaneous dilational tracheostomy group [（5.80 ± 1.19） min vs. （7.65 ± 1.05） min, （8.33 ± 3.30） ml vs. （11.33 ± 4.34） ml, （1.08 ± 2.96） cm vs. （1.27 ± 2.54） cm] （P〈0.05）. The incision healing time and incidence of complications after operation of percutaneous dilational tracheostomy group had no statistical significance compared with modified percutaneous dilational tracheostomy group （P〉0.05）. Conclusions The modified percutaneous dilational tracheostomy can save operation time, and reduce intraoperative blood loss, so it can be widely used.