抗血小板治疗神经重症患者行经皮气管切开术的安全性探讨

The safety of percutaneous tracheotomy for critically neurological and neurosurgical patients received antiplatelet or anticoagulation therapies

目的探讨抗血小板治疗神经重症患者行经皮气管切开术(percutaneous dilatational tracheotomy,PDT)的安全性。方法选取2015年1月至2018年12月在江苏省江阴市人民医院行床旁气管切开术并接受抗血小板治疗的245例神经重症患者,根据气管切开方式不同分为研究组(192例,采取PDT)和对照组(53例,采取手术气管切开),比较两组患者手术时间术中及术后出血、切口感染、气胸发生情况。结果研究组患者手术时间明显短于对照组(P<0.01),切口长度明显小于对照组(P<0.01),切口感染发生率明显低于对照组(P<0.05)。研究组患者术中出血、迟发出血及出血后加重肺不张的情况与对照组比较差异无显著性(P>0.05)。迟发出血患者的切口长度、躁动发生率、血小板低发生率均高于无迟发出血组,差异有显著性(P<0.05)。结论抗血小板治疗的神经重症患者行PDT是安全的。

Objective To investigate the safety of percutaneous tracheotomy in critically neurological and neurosurgical patients receiveing antiplatelet treatment.Method The patients receiving antiplatelet admited during January 2015 and December 2018 were divided into percutaneous tracheostomy group(192 cases experimental group)and surgical tracheotomy group(53 cases,control group).The general information,operation time,incision size,bleeding complications,atelectasis caused by bleeding,incision infection and pneumothorax between two groups were evaluated.Result The operation time and incision length of the experimental group was significant shorter than control group(P<0.01).The incision infection rates in the experimental group was lower than control group(P<0.05).There were no statistically significant differences with intraoperative bleeding and delayed bleeding rates between two groups.There were significant differences in the rate of restlessness,low platelet count and incision length between patients with delayed bleeding and none delayed bleeding.Conclusion Percutaneous tracheostomy is safe for critically neurological and neurosurgical patients receiveing antiplatelet treatment.