床旁经皮穿刺气管切开术在 ICU 的应用研究

摘要

Objective To investigate safety and advantage of percutaneous dilatational tracheostomy beside bed applied in intensive care unit (ICU). Methods This study provided percutaneous dilatational tracheostomy beside bed (Portex method) (group B, 18 cases) and general surgical tracheostomy (group A, 18 cases) randomly in 36 patients with indication of tracheostomy and no contraindication. Observation was made on intraoperative bleeding volume, operation time, operation complications, operation cost ICU hospitalization time, and incidence of newly-onset pneumonia of the two groups. Results Group B had less intraoperative bleeding volume, 24 h bleeding volume and shorter operation time than group A. Their differences all had statistical significance (P<0.01). Group B had more operation cost than group A (P<0.01). There was no statistically significant difference of ICU hospitalization time and incidence of pneumonia between the two groups (P>0.05). Conclusion Implement of percutaneous dilatational tracheostomy beside bed (Portex method) in ICU is safe, quick, convenient, along with few bleeding volume. Comparing with traditional tracheotomy, this method contains obvious advantages.%目的：探讨床旁经皮穿刺气管切开术在重症加强护理病房(ICU)中应用的安全性及应用优势。方法本研究采用随机、对照的方法对 ICU 病房有气管切开指征且无禁忌证的36例患者分别采用床旁经皮穿刺气管切开术(Portex 法)(B 组,18例)及传统外科气管切开术(A 组,18例),观察两组患者术中出血量、手术时间、手术并发症、手术费用、ICU 住院时间及新发肺炎发生率等情况。结果 B 组患者术中出血量、24 h 内出血量均较 A 组少,手术时间较 A 组缩短,差异均有统计学意义(P<0.01),手术费用 B 组较 A 组增加(P<0.01)；两组患者 ICU 住院时间及肺炎发生率差异无统计学意义(P>0.05)。结论在 ICU 病房,床旁完成经皮穿刺气管切开术(Portex 法) 安全、简便、快捷,且出血量少,相对于传统的气管切开术,更具有应用优势。