摘要
目的通过比较纤维支气管镜(纤支镜)引导下经皮扩张气管切开术(PDT)和开放性气管切开术(OT)在困难气管切开患者中的的应用,评价PDT在困难气管切开患者中的应用价值及疗效。方法将90例ICU内具有气管切开适应证但属于困难切开的患者随机分成PDT组和OT组。比较两组手术时间、术中出血量、切口的大小、切口愈合时间、术中生命体征变化及手术相关并发症的发生率。结果 PDT组和OT组手术时间分别为(10.8±2.1)和(26.8±3.7)min;出血量分别为(10.1±4.5)和(19.3±6.2)mL;切口长度分别为(1.5±0.2)和(2.2±0.6)cm;切口愈合时间分别为(3.2±1.0)和(5.3±2.4)d,两组比较差异有显著性(P<0.05)。手术过程中两组患者平均血压和心率的变化值分别为(5.6±1.8)和(11.6±4.5)mmHg,(7.3±2.4)和(16.1±5.2)次/min,两组比较差异有显著性(P<0.05),氧饱和度的变化为(5.1±0.9)%和(6.3±1.7)%,两组比较差异无显著性(P>0.05),术后切口出血量、切口感染、皮下气肿、纵膈气胸、气管内肉芽增生及气管食管瘘等并发症发生率,两组比较差异有显著性(P<0.05)。结论纤支镜直视下PDT与传统OT相比具有微创、安全、并发症发生率低等优点,尤其适用于困难气管切开患者。
[Objective] To evaluate the clinical value of percutaneous dilation tracheostomy（PDT） by studying and comparing the application of PDT and open tracheotomy（OT） in tracheotomy difficult patients.[Methods] A prospective randomized study was carried out in 90 patients with tracheotomy difficult from October 2008 to December 2011.These patients were divided into PDT and OT groups.The operative time,blood loss,the length and heal time of the incision,vital sighs in operative and the incidence of postoperative complications were compared between the two groups.[Results] The operative time,blood loss,the length and heal time of the incision in the PDT group were significantly different from that in the two groups（P 0.05）.[（10.8±2.1） min vs.（26.8±3.7）min,（10.1±4.5） mL vs.（19.3±6.2）mL,（1.5±0.2）cm vs.（2.2±0.6）cm,（3.2±1.0） d vs.（5.3±2.4） d].The changer of the vital signs mean artery pressure and heart rate in the PDT group was significantly milder than those in the OT group（P 0.05） [（5.6 ± 1.8）mmHg vs.（11.6±4.5）mmHg,（7.3±2.4） times /min vs.（16.1±5.2） times /min.The changer in oxygen saturation was no significant difference between two groups（P 0.05） [（5.1±0.9）% vs.（6.3±1.7）].Furthermore,the complication rate such as postoperative incision bleeding,incision infection,subcutaneous emphysema,mediastinum pneumothorax,tracheal granulation and tracheoeso-phageal fistula complication rate were significant different（P 0.05）.[Conclusion] PDT guiding by bronchoscopy is a safe and minimally invasive with a high rate of success and low rate of complication.This could be a good choice for difficult tracheotomy patients.
出处
《中国内镜杂志》
CSCD
北大核心
2012年第10期1073-1076,共4页
China Journal of Endoscopy
