三种气管切开术在危重症患者中的应用效果比较

摘要

Objective To compare the application effect of traditional surgical tracheotomy,percutaneous dilational tracheostomy and modified percutaneous dilational tracheostomy in the treatment of critically ill patients. Methods A total of 155 critically ill patients undergoing tracheotomy and mechanical ventilation were selected in the Osteopathic Hospital of Wendeng County,and they were divided into A group(n = 45),B group(n = 59)and C group(n = 51)according to the methods of tracheotomy. Patients of A group received traditional surgical tracheotomy, of B group received percutaneous dilational tracheostomy,of C group received modified percutaneous dilational tracheostomy. Operation - related index,incidence of perioperative complications and incidence of complications after 1 week of operation were compared among the three groups. Results Duration of operation,diameter of incision and incision healing time of B group and C group were statistically significantly shorter than those of A group,and intraoperative blood loss of B group and C group was statistically significantly less than that of A group, respectively ( P < 0. 05 ); while no statistically significant differences of duration of operation, intraoperative blood loss,diameter of incision or incision healing time was found between B group and C group(P > 0. 05). The incidence of perioperative complications and incidence of complications after 1 week of operation of B group and C group were statistically significantly lower than those of A group( P < 0. 05);incidence of perioperative complications and incidence of complications after 1 week of operation of C group were statistically significantly lower than those of B group( P < 0. 05). Conclusion Compared with traditional surgical tracheotomy,modified percutaneous dilational tracheostomy can effectively shorten the duration of operation and reduce the surgical trauma,and it has less complications than percutaneous dilational tracheostomy.%目的 比较传统外科气管切开术(TST)、经皮扩张气管切开术(PDT)、改良经皮扩张气管切开术(MPDT)在危重症患者中的应用效果.方法 选取2008年5月—2015年5月在山东省文登整骨医院行气管切开机械通气的危重症患者155例,按照气管切开方式分为TST组45例、PDT组59例、MPDT组51例.TST组患者采用TST进行气管切开,PDT组患者采用PDT进行气管切开,MPDT组患者采用MPDT进行气管切开.比较3组患者手术情况、围术期并发症及术后1周并发症情况.结果 PDT组、MPDT组患者手术时间、切口直径、切口愈合时间均短于TST组,术中出血量均少于TST组(P<0.05);PDT组与MPDT组患者手术时间、术中出血量、切口直径、切口愈合时间比较,差异无统计学意义(P>0.05).PDT组、MPDT组患者围术期及术后1周并发症发生率低于TST组(P<0.05);MPDT组患者围术期及术后1周并发症发生率低于PDT组(P<0.05).结论 MPDT较TST能有效缩短手术时间及减少手术创伤,且较PDT并发症少.