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目的研究单步经皮旋转气管切开术在接受持续性床旁血液滤过全身肝素化抗凝患者中应用的安全性。方法对黑龙江省医院重症医学科2011年1月—2013年3月接受单步经皮旋转气管切开术60例病例进行比较分析,其中对照组为凝血机制正常病例30例;观察组为凝血机制正常,但同时接受持续性床旁血液滤过全身肝素化抗凝治疗的病例30例。观察2组患者术后出血时间、24 h内出血量、个体总出血量、术后1周内切口感染例数,进行统计学比较。结果观察组术后出血时间平均为(2.10±0.46)h,较对照组平均值(1.65±0.43)h略长;2组均于24 h内止血,24 h内出血量即为总出血量,观察组平均值为(17.67±9.16)ml,对照组平均值为(16.97±7.01)ml,2组比较差异无统计学意义;术后1周后2组除部分脱组病例外,切口感染例数均为2例。结论与凝血机制正常患者相比,单步经皮旋转气管切开术在持续性床旁血液滤过全身肝素化抗凝病人中的应用是相对安全的,可以临床应用。
Objective To study the safety of single-step percutaneous transhepatic tracheostomy in patients undergoing continuous-bed hemofiltration of whole-body heparinized anticoagulants. Methods A total of 60 cases with single-step percutaneous transhepatic tracheostomy in the Department of Critical Care Medicine of Heilongjiang Provincial Hospital from January 2011 to March 2013 were compared and analyzed. Among them, the control group consisted of 30 cases of normal coagulation mechanism and the observation group was coagulation mechanism Normal, but at the same time accept the continuous bedside hemofiltration of heparinized anticoagulant therapy in 30 cases. The postoperative bleeding time, the amount of bleeding within 24 hours, the total amount of bleeding and the number of incision infection within 1 week after operation were observed in two groups for statistical comparison. Results The mean postoperative bleeding time in the observation group was (2.10 ± 0.46) h, slightly longer than that in the control group (1.65 ± 0.43) h. Both groups were within 24 hours of bleeding, and the amount of bleeding within 24 hours was the total amount of bleeding. (17.67 ± 9.16) ml for the control group and (16.97 ± 7.01) ml for the control group. There was no significant difference between the two groups after 1 week and the number of incision infection All in 2 cases. Conclusion Compared with patients with normal coagulation mechanism, the application of single-step percutaneous transhepatic tracheostomy in continuous-bed hemofiltration in patients with systemic heparinized anticoagulation is relatively safe and can be used clinically.