重症监护病房行经皮气管切开的疗效及术后呼吸道感染风险特征观察

Efficacy of percutaneous tracheostomy in intensive care unit and the risk of respiratory infection after surgery

目的观察重症监护病房(intensive care unit,ICU)行经皮气管切开的疗效及术后呼吸道感染风险特征。方法选取ICU患者94例,随机分为观察组与对照组,各组47例。观察组采取经皮气管切开,对照组采取传统气管切开,比较2组手术时间、术中出血量、切口长度、切口愈合时间、手术并发症发生率,并对经皮气管切开术后呼吸道感染患者的感染情况进行分析。结果观察组手术时间(10.15±4.36)min、术中出血量(6.41±1.33)m L、切口长度(1.32±0.41)cm、切口愈合时间(3.52±0.71)d、手术并发症发生率为8.51%,均低于对照组(P<0.05)。多因素回归分析,气管插管保留≥1周、机械通气时间≥1周、合并基础疾病为气管切开术后呼吸道感染的危险因素。其中湿化瓶、呼吸机接口、吸引器连接管为气管切开术后引起呼吸道感染最常见的部位,且病原菌以铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌等为主。结论经皮气管切开术用于ICU中的手术相关指标满意,气管插管保留≥1周、机械通气时间≥1周、合并基础疾病是术后呼吸道感染的危险因素。

Objective To observe the efficiency of percutaneous tracheostomy in intensive care unit（ ICU） and the risk of respiratory infection after surgery. Methods Ninety-four patients in ICU were randomly divided into observation group and control group,47 cases in each group. The observation group was treated with percutaneous tracheotomy,while the control group was treated with traditional tracheotomy. The duration of surgery,intraoperative blood loss,length of incision,incision healing time and total incidence rate of surgical complications were compared between the two groups,and the respiratory tract infection after percutaneous tracheostomy was analyzed. Results The duration of surgery（ 10. 15±4. 36） min,intraoperative blood loss（ 6. 41 ± 1. 33） mL,length of incision（ 1. 32 ± 0. 41） cm,incision healing time（ 3. 52 ± 0. 71） d,and surgical complications（ 8. 51%） of the observation group were lower and less than those of the control group（ P〈0. 05）.Multiple Logistic regression analysis indicated the percentage of retained tracheal intubation ≥1 week,duration of mechanical ventilation ≥1 week and being complicated with underlying diseases were the risk factors for respiratory tract infection after tracheotomy. The humidification bottle,connection of respirator and connection pipe of suction were the most common site of respiratory tract infection after tracheotomy,and Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus were the most common pathogenic bacteria. Conclusion The outcomes of percutaneous tracheostomy in ICU is satisfactory. Tracheal intubation retained over 1 week and mechanical ventilation longer than1 week,with basic diseases are the risk factors of postoperative respiratory tract infection.