经皮穿刺扩张气管切开术在急危重症患者气道开通的时效性研究

Time-effectiveness of percutaneous dilational tracheostomy in airway positioning for emergency and critically ill patients

目的探讨经皮穿刺扩张气管切开术(PDT)在急危重症患者紧急气道开通的时效性价值。方法收集解放军总医院第一附属医院2004年7月至2014年7月间在急诊科、ICU科工作时救治窒息及呼吸衰竭的153例行气管切开术的ICU患者,分为PDT组和常规气管切开手术(OT)组,PDT组56例,男性34例,女性22例;OT组97例,男性48例,女性49例。从操作时间、低氧持续时间、低血压发生率、术后出血、切口愈合等五方面比较PDT和OT在急危重症患者气道开通的急救时效性及临床应用安全性。结果经皮穿刺气管扩切术操作时间PDT组为(6.0±2.2)min,OT组为(17.6±5.5)min(P<0.001);经皮穿刺气管扩切术低氧持续时间PDT组为(10.8±2.8)min,OT组为(37.6±6.1)min(P<0.001);经皮穿刺气管扩切术发生低血压PDT组为25%,OT组为24.7%(P>0.05);经皮穿刺气管扩切术术后出血PDT组为(7.3±4.2)m L,OT组为(28.4±19.8)m L(P<0.001);经皮穿刺气管扩切术切口愈合时间PDT组为(4.4±1.3)d,OT组为(7.8±2.5)d(P<0.001)。结论 PDT在急重症患者紧急开通气道的时效性和安全性均优于OT。

Objective To investigate the effectiveness of percutaneous dilational tracheostomy( PDT) in airway positioning for emergency and critically ill patients. Methods A review was done on clinical data of 153 critically ill patients admitted into the Department of Emergency and ICU,First Hospital Affiliated to the General Hospital of the PLA from July 2004 to July 2014. All patients were treated with tracheotomy. There were 34 males and 22 females in PDT group,while 48 males and 49 females in conventional tracheal incision operation tracheotomy( OT) group( OT group). The time-effectiveness and safety of PDT and OT were compared in clinical application of tracheotomy from aspects of operation time,low oxygen from the continuous time,hypotension rate,postoperative bleeding,wound healing. Results Operation time of PDT and OT groups was( 6. 0 ± 2. 2) min and( 17. 6 ± 5. 5) min,respectively( P < 0. 001). Continuous time of low oxygen in PDT and OT groups were( 10. 8 ± 2. 8) min and( 37. 6 ± 6. 1) min,respectively( P < 0. 001).Hypotension rate in PDT and OT groups was 25% and 24. 7%,respectively( P > 0. 05). Postoperative bleeding in PDT and OT groups was( 4. 0 ± 0. 7) m L and( 5. 3 ± 1. 4) m L,respectively( P < 0. 001). Wound healing time in PDT and OT groups were( 4. 4 ± 1. 3) d and( 7. 8 ± 2. 5) d,respectively( P < 0. 001).Conclusion PDT is better than OT in airway positioning for emergency and critically ill patients.