不同退管时机对重症患者经皮扩张气管切开术的影响

Effects of Different Timing of Withdrawal on Percutaneous Dilational Tracheostomy in Critically Ill Patients

目的探讨不同退管时机对重症患者经皮扩张气管切开术(PDT)的影响。方法 162例接受PDT治疗的重症患者随机分为两组各81例。术前退管组在PDT术前退出部分气管插管导管,延迟退管组待扩张钳扩张完毕后再退出部分气管插管导管。比较两组的术中操作指标和术后并发症。结果两组的手术操作时间、术中出血量、一次成功率和中转传统手术比例比较无统计学差异(P>0.05);延迟退管组的术中误吸比例、生命体征显著波动比例、导丝置入困难比例、套管置入困难比例均高于术前退管组,丙泊酚、咪唑安定、芬太尼使用剂量均高于术前退管组(P<0.05)。延迟退管组的总并发症发生率高于术前退管组(P<0.05)。结论标准流程的术前退管具有更高的临床操作性和更低的技术风险,且有助于降低临床麻醉药物使用剂量。

Objective To explore the effects of different timing of withdrawal on percutaneous dilational tracheostomy(PDT) in critically ill patients.Methods A total of 162 critically ill patients with PDT treatment were randomly divided into two groups equally. Part of the tracheal intubation catheter was withdrawn before PDT in the preoperative withdrawal group, and part of tracheal intubation catheter was withdrawn after completion of the retraction forceps expansion in the delayed withdrawal group. The intraoperative operation indicators and postoperative complications were compared between two groups. Results No significant difference was found in the operation time,intraoperative bleeding volume, one-time success rate and proportion of transfer to traditional surgery between two groups(P>0.05). The proportions of intraoperative aspiration, obvious vital signs fluctuation, difficult guide wire insertion and difficult cannula insertion of delayed withdrawal group was higher than those of preoperative withdrawal group, and the dosages of propofol, midazolam and fentanyl were higher than those of preoperative withdrawal group(P<0.05). The total incidence of complications of delayed withdrawal group was higher than that of preoperative withdrawal group(P<0.05).Conclusions Preoperative catheter withdrawal with standard procedures has higher clinical operability and lower technical risk, and helps reduce the dosage of clinical anesthetics.