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目的:比较经皮扩张气管切开术(percutaneous dilational tracheostomy,PDT)与常规气管切开术(surgical tracheostomy,ST)在急危重患者的应用效果和并发症,评价PDT的临床价值。方法:选择2012-01-2014-04我院需气管切开的ICU患者,随机分成2组(PDT组与ST组),比较2组患者手术时间、切口长度、术中最低血氧饱和度、术中和术后3d出血以及术后7d切口感染的情况。结果:234例患者纳入研究并全部顺利完成手术。PDT组和ST组在平均手术时间、切口长度、术中最低血氧饱和度以及术中、术后出血情况方面差异无统计学意义。术后7d切口感染情况比较,PDT组轻度、中度及重度感染发生率为13.1%(16/122)、4.9%(6/122)、0.8%(1/122),ST组分别20.5%(23/112)、9.8%(11/112)、2.7%(3/112),差异有统计学意义(P<0.05)。ST组有1例发生皮下气肿,2组均无气胸、意外脱管、术中心跳停搏及术后食管气管瘘。结论:与ST比较,PDT具有手术时间短、手术切口小及术后感染风险小等优点,但在术中、术后出血差异无统计学意义。PDF操作简单、快捷、高效,适合于抢救困难插管而又需紧急开放气道的急危重症患者。
Objective: To compare the clinical effects and complications of percutaneous dilational tracheostomy (PDT) and conventional tracheostomy (ST) in critically ill patients and evaluate the clinical value of PDT. Methods: The ICU patients who underwent tracheotomy in our hospital from January 2012 to April 2014 were randomly divided into two groups (PDT group and ST group). The operation time, incision length, minimum oxygen saturation, Intraoperative and postoperative bleeding after 3 days and incision infection after 7d. Results: 234 patients were included in the study and all were successfully completed. There was no significant difference between PDT group and ST group in mean operative time, incision length, lowest oxygen saturation in operation, and intraoperative and postoperative bleeding. The incidence of mild, moderate and severe infections in PDT group was 13.1% (16/122), 4.9% (6/122), 0.8% (1/122) in the PDT group and 20.5% in the ST group (23/112), 9.8% (11/112) and 2.7% (3/112), respectively. The difference was statistically significant (P <0.05). There was 1 case of subcutaneous emphysema in ST group, no pneumothorax, accidental debridement, cardiac arrest and postoperative esophageal tracheal fistula in both groups. Conclusion: Compared with ST, PDT has the advantages of short operation time, small incision and less risk of postoperative infection. However, there is no significant difference between the two groups in intraoperative and postoperative bleeding. PDF Simple, fast and efficient, it is suitable for critically ill patients who need urgent emergency airway rescue.