经皮穿刺扩张气管切开术在危重患者中的应用

Application of Percutaneous Puncture Dilational Tracheostomy in Critically Ill Patients

目的分析经皮穿刺扩张气管切开术在危重患者中的应用效果。方法方便选择2014年1月—2016年12月收治的30例危重患者,其中颅脑损伤有13例,脑出血有17例。有25例昏迷,5例合并多发伤,所有患者均采用经皮穿刺扩张气管切开术进行治疗。分析预后良好率;气管切开时间、手术切口长度、手术过程出血量;患者皮下气肿、套管脱出、插管失败、肉芽形成等并发症发生率。结果 30例患者中有28例预后良好,良好率为93.33%。30例患者中,仅有1例出现皮下气肿,无套管脱出、插管失败、肉芽形成等并发症发生,发生率3.33%。30例患者中气管切开时间、手术切口长度、手术过程出血量分别为(7.39±2.77)min、(1.39±0.12)cm、(6.61±2.59)m L。结论经皮穿刺扩张气管切开术在危重患者中的应用效果确切,可有效缩短操作时间,减少手术组织损伤,手术切口小,并发症少,无肉芽形成或套管脱出等并发症发生,安全性较高,可有效改善患者预后,值得推广。

Objective To analyze the application effect of percutaneous puncture dilational tracheostomy in critically ill patients. Methods 30 cases of critically ill patients from January 2014 to December 2016 were convenient selected, including 13 cases with cerebral injury and 17 cases with cerebral hemorrhage, and 25 cases were coma, and 5 cases were complicated by multiple injuries, and all patients were treated with percutaneous puncture dilational tracheostomy, and the prognosis good rate, tracheotomy time, operation cut length, bleeding amount in the operation course and incidence rate of complications such as subcutaneous emphysema, prolapse of the cannula, failure of intubation and granulation were analyzed. Results Of 30 cases, the prognosis of 28 cases was good, and the good rate was 93.33%, of 30 cases, only 1 case was with subcutaneous emphysema, and there were no complications such as cannula failure, intubation failure, granulation formation, and the incidence rate was 3.33%, and the tracheotomy time, operation cut length and bleeding amount in the operation course of 30 cases of patients were respectively(7.39±2.77)min,(1.39±0.12)cm,(6.61±2.59)m L. Conclusion The application effect of percutaneous puncture dilational tracheostomy in critically ill patients is definite, which can effectively shorten the operation time, reduce the operation tissue injury with small operation incision, few complications and high safety but without complications of granulation formation or cannula prolapsed, and it can effectively improve the prognosis of patients, and it is worth promotion.