摘要
目的通过比较传统开放性气管切开术(open tracheostomy,OT)和经皮扩张气管切开术(percutaneous dilational tracheostomy,PDT)在心脏外科术后危重病人中的应用,评价PDT在心外科的临床应用价值。方法40例正中开胸心脏手术后危重患者,2002年1月～2003年7月为OT组,2003年8月～2008年2月为PDT组,各20例,观察手术时间、切口长度、愈合时间、术中出血、生命体征的波动及术后不良反应等情况。结果PDT组手术时间(8.8±2.2)min、切口长度(1.3±0.2)cm、切口愈合时间(3.9±0.9)d,与OT组的(21.5±5.3)min、(3.4±0.5)cm、(5.9±1.2)d相比,均有显著性差异(t=-9.897,-17.440,-5.963,P=0.000);术中Ⅱ度出血PDT组明显少于OT组[1例(5%)vs 13例(65%),χ2=15.824,P=0.000];术中平均动脉压、心率、脉搏血氧饱和度的波动PDT组明显小于OT组[1～5(中位数2)mm Hg vs 1～20(中位数3.5)mm Hg,Z=-2.959,P=0.003;3～12(中位数5.5)次/min vs 7～70(中位数10)次/min,Z=-3.956,P=0.000;0～4%(中位数2%)vs 0～31%(中位数3.5%),Z=-3.548,P=0.000];不良反应切口溢痰的发生率PDT组明显低于OT组[1例(5%)vs 8例(40%),χ2=5.161,P=0.023];总并发症发生率PDT组明显低于OT组[1例(5%)vs 12例(60%),χ2=13.789,P=0.000)。结论PDT具有快速、创伤小、手术操作精确、易掌握、成功率高、并发症少等优势,是心血管术后危重病人气管切开的较好选择。
Objective To discuss the value of percutaneous dilatational tracheotomy （PDT） for cardiosurgery in intensive care unit by comparing its outcomes with that of open traeheotomy （ OT）. Methods A prospective study was conducted on 40 severe patients undergoing cardiosurgery. The patients were divided into PDT （treated from January 2002 to July 2003） and OT groups （treated from August 2003 to February 2008） with 20 cases in each. The operation time, length and heal time of the incision, blood loss, vital signs, and postoperative complications were compared between the two groups. Results The operation time, length and heal time of the incision in the PDT group were significantly different from that in the OT group [ （8.8 ±2. 2） rain vs （21.5±5.3） min, t= -9.897; （1.3±0.2） cm vs （3.4 ±0.5） cm, t = -17.440; and （3.9 ±0.9） d vs （5.9 ± 1.2） d, t = -5.963; P = 0. 000]. One patient in the PDT group （5%） had Ⅱdegree blood loss during the operation that was significantly less than those in the OT group （13 patients, 65% , X^2 = 15. 824 ,P = 0. 000）. The level of the vital signs change in the PDT group was significantly milder than those in the OT group [ MAP： 1 - 5 mm Hg （median 2） vs 1 -20 mm Hg （median 3.5） , Z = - 2. 959, P =0. 003; heart rate： 3-12 beats/min （median5.5） vs7-70 beats/min （median 10）, Z= -3.956, P=0.000; SpO2： 0-4% （median 2%） vs0- 31% （median 3.5% ）, Z = -3. 548, P = 0. 000 ]. Furthermore, the rate of ineisional leakage of sputum and overall rate of complications in the PDT group were significantly lower than those in the OT group. [ 1 （5%） vs 8 （40%） , X^2 = 5. 161, P = 0. 023; and 1 （5%） vs 12 （60%）, X^2 = 13. 789, P = 0. 000 ]. Conclusions PDT is a safe and minimally invasive technique with a high rate of success and low rate of complications. The method is easy to operate, and thus could be a good choice for severe patients after cardiovascular surgeries.
出处
《中国微创外科杂志》
CSCD
2009年第2期137-140,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
微创
气管切开术
心脏外科
Minimally invasive surgery
Pereutaneous dilatational tracheotomy
Cardiosurgery
