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目的探讨经皮旋转扩张气管切开术在危重病中的应用价值。方法回顾性分析重症监护病房(ICU)中气管切开的危重病患者共88例,其中经皮扩张气管切开术组(PDT组)52例,常规外科气管切开术组(ST组)36例。比较两组手术操作时间、术中出血量、并发症发生率。结果PDT组手术操作时间为4～20 min,平均(8.6±2.8)min,ST组为13～28 min,平均(18.2±3.6)min,PDT组手术操作时间较ST组显著缩短(P<0.01);PDT组术中出血量<5 ml的48例,>5 ml的4例,ST组<5 ml的4例,>5 ml的32例,PDT组术中出血量较ST组显著减少(P<0.01);PDT组并发症发生率为3.8%,ST组为11.1%,PDT组并发症发生率较ST组明显减少(P<0.05)。结论经皮旋转扩张气管切开术是一种快速、术中出血量少、并发症少的微创气管切开术。除未成年人外,PDT可以广泛应用于ICU中的危重病患者。
Objective To investigate the value of percutaneous rotational dilatation and tracheostomy in critically ill patients. Methods A total of 88 critically ill patients with tracheotomy in intensive care unit (ICU) were retrospectively analyzed. Among them, 52 patients in the PDT group and 36 patients in the conventional surgical tracheotomy group (ST group) example. The operation time, intraoperative blood loss and complication rate were compared between the two groups. Results The operation time in PDT group was 4-20 min (mean, 8.6 ± 2.8) min, in group ST was 13-28 min (mean, 18.2 ± 3.6) min, and the operation time in PDT group was significantly shorter than that in ST group (P <0.01) ); 48 cases of bleeding less than 5 ml in PDT group, 4 cases of> 5 ml in 4 cases, 5 cases in ST group and 32 cases of> 5 ml in PDT group. The bleeding volume in PDT group was significantly lower than that in ST group P <0.01). The incidence of complications in PDT group was 3.8% and that in ST group was 11.1%. The incidence of complications in PDT group was significantly lower than that in ST group (P <0.05). Conclusion Percutaneous rotational dilatation and tracheostomy is a kind of minimally invasive tracheotomy with rapid, less intraoperative bleeding and fewer complications. In addition to minors, PDT can be widely used in critically ill patients in the ICU.