改良经皮扩张气管切开术的评价

常规经皮扩张气管切开术存在扩张困难、导丝易弯折导致手术失败率较高的缺点，本研究拟对改良经皮气管切开术进行评价。     

单中心10年经皮扩张气管切开术的临床分析

目的评价ICU危重病患者床边开展经皮扩张气管切开术（percutaneous dilational tracheostomy,PDT）的安全性。方法 2001年5月-2010年12月,对421例需长时间机械通气的危重病患者在床边行PDT,男309例（73.4%）,女112例（26.6%）,年龄（57.6±19.7）岁,PDT前插管时间（10.2±5.7）d。采用经导丝导引下经皮扩张钳气管切开（guide wire dilatingforceps,GWDF）技术。记录患者一般资料、PDT前插管时间、PDT手术时间、PDT后机械通气（MV）时间、总MV时间和气管套管留置时间,同时记录术中并发症、术后3 d内和3 d后并发症。回顾性记录住ICU时间和住院时间以及患者预后。结果 PDT手术时间（10.3±3.8）min,PDT后MV时间1-249 d（中位数17.0 d）,总MV时间6-260 d（中位数26.0 d）,气管套管留置时间21-186 d（中位数43.5 d）。术中并发症发生率8.3%（35例）,3 d内并发症发生率5.9%（25例）,3 d后并发症发生率4.0%（17例）。住ICU时间6-331 d（中位数32.4 d）,ICU死亡率16.4%（69例）。住院时间6-653 d（中位数58.5d）,死亡率18.5%（78例）。结论 PDT技术是创伤小、操作简单、并发症少和安全性高的微创外科方法,是危重病患者预期长时间MV的较好选择。     

非纤维支气管镜辅助经皮旋转扩张气管切开术的临床应用

目的评价在非纤维支气管镜辅助下开展经皮旋转扩张气管切开术的临床应用价值。方法2008年1月至2009年2月ICU病区符合气管切开手术指征危重患者30例,采用经皮旋转扩张气管切开术,手术均在非纤维支气管镜辅助下完成;观察手术时间、术中出血情况及其他相关并发症。结果本组平均手术时间（6．0±0．5）min,术中出血量极少,均为Ⅰ度出血,无其他严重并发症发生。结论非纤维支气管镜辅助下行经皮旋转扩张气管切开术,具有手术时间短、并发症少等优点,只要谨慎操作,是安全有效的,值得临床推广。     

经皮扩张气管切开术与传统气管切开术用于不同体质量指数患者的临床对比研究

目的 探讨经皮扩张气管切开术(PDT)和传统气管切开术(TT)用于不同体质量指数(BMI)患者的临床效果.方法 前瞻性纳入2018-02—2020-03成都市4家三级综合医院重症医学科行气管切开术的患者,根据手术方法分为PDT组和TT组.比较2组患者的基线资料、手术时间、术中出血量,以及术后并发症发生率.结果 共纳入1...     

微创气道管理新方法——经皮扩张气管切开术

作为一种解决气道梗阻的有效措施,气管切开术广泛应用于急救复苏和围术期的气道管理。传统的气管切开术不仅需要特定的训练、器械和一定的操作时间,而且皮肤切口较大,需分离颈前组织和切开气管前壁,因此并发症较多。随着微创技术的开展,几种在床旁经皮气管切开术（percutaneous dilatational tracheostomy,PDT）逐渐普及。     

经皮扩张气管切开术在救治重症颅脑疾病中的应用

目的 比较传统开放性气管切开术(OT)与经皮扩张气管切开术(PDT)在救治重症颅脑疾病中的应用。方法 回顾性分析OT组与PDT组并发症发生率、操作相关病死率和操作时间。结果 PDT组无1例发生操作相关死亡，仅1例发生并发症；OT组不同程度发生并发症，其中1例发生拔管后猝死；PDT组操作时间较OT组明显缩短。结论 经皮扩张气管切开术在重症颅脑疾病患者中应用具有操作时间短，并发症及操作相关死亡率低的优点，利于重症颅脑疾病的治疗。     

经皮扩张气管切开术在口腔颌面外科麻醉中的应用

目的探讨术前经皮扩张气管切开术(percutaneous dilatational tracheotomy,PDT)在口腔颌面外科手术麻醉中的临床应用价值,并与同期传统外科气管切开术(surgical tracheotomy,ST)进行比较。方法收集2013年5月至2015年5月,在我院口腔颌面外科行肿瘤根治伴皮瓣转移修复并且做气管切开术的124例患者资料,包括患者的一般资料、麻醉用药、气管切开时的生命体征、手术时间、出血量、并发症发生情况等。结果 124例患者中41例行PDT(P组),83例行ST(S组),两组患者一般资料差异无统计学意义。P组切口长度和手术时间均明显短于S组(P0.05),术中出血量明显少于S组(P0.05)。两组并发症发生率差异无统计学意义。结论与ST相比,PDT具有更多优点,更加适合于口腔颌面外科手术的气道管理。     

经皮扩张气管切开术在困难气道处理中的应用

目的 观察经皮扩张气管切开的应用效果.方法 采用经皮扩张气管切开器械,气管内置入导丝,引导扩张器和扩张钳,钝性扩张气管前组织及气管环间膜,对32例困难气道患者进行气管切开.结果 经皮扩张气管切开术手术时间短、术中出血少、均顺利完成.结论 经皮扩张气管切开术具有操作简单、并发症少、切口愈合后疤痕不明显等优点.适用于困难气道需要气管切开的患者.     

经皮穿刺扩张气管切开术25例报告

我院2004年5月-2009年8月行经皮穿刺扩张气管切开术25例,效果满意,现报道如下。     

Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer

Background Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB).Methods Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded.Results In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be completely safe in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062).Conclusions The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.     

The laryngeal mask simplifies airway management during percutaneous dilational tracheostomy

The Laryngeal Mask Airway (LMA) is used for many procedures which previously required endotracheal intubation. Percutaneous Dilational Tracheostomy (PCT) facilitates the bedside insertion of a tracheostomy tube in the Intensive Care Unit. Most patients requiring this procedure are intubated with a conventional endotracheal tube. Insertion of a LMA has advantages over tracheal intubation for PCT mainly because the artificial airway lies remote from the operating field. Three cases are reported to illustrate these advantages.     

经皮穿刺气管切开术在紧急抢救中的应用价值

目的：比较经皮穿刺气管切开术（PDT）与传统开放式气管切开术（OT）在手术操作和并发症上的差异,探讨其在危重患者紧急抢救中的应用价值.方法：30例急诊拟行气管切开术的患者,随机分为两组.OT组15例行传统气管切开术,PDT组15例行经皮穿刺气管切开术,记录并比较两组患者的手术时间、切口大小、术中出血量及术后并发症、心率、血压和氧饱和度的变化.结果：PDT组手术时间、切口大小、术中出血、术后并发症发生率均明显低于OT组,术后1 h心率和收缩压也明显低于OT组（P均〈0.05）,但两组术后1 h的平均动脉压和血氧饱和度之间差异无显著性（P〉0.05）.结论：与传统气管切开术比较,经皮穿刺气管切开术具有手术时间短、切口小、出血量少、并发症少等优点,适合在紧急抢救中应用.     

Long-term outcome after percutaneous dilational tracheostomy Endoscopic and spirometry findings

We studied 41 patients who had previously undergone percutaneous dilational tracheostomy at least 6 months following tracheal decannulation. The patients were examined using laryngotracheoscopy and spirometry to assess the long-term anatomical and functional consequences of percutaneous dilational tracheostomy. Apart from one patient who had requested a scar revision, no patient was symptomatic. A significant (>10%) tracheal stenosis was identified in four asymptomatic patients, two of whom also had spirometric evidence of this obstruction. These results suggest that the long-term outcome after percutaneous tracheostomy is at least as good as that following conventional surgical tracheostomy. Refinements of the percutaneous technique, such as endoscopic guidance, may further improve the results.     

Fantoni translaryngeal tracheostomy versus ciaglia blue rhino percutaneous tracheostomy: A retrospective comparison

Purpose  To compare the operative technique and complications of the Fantoni tracheostomy (TLT) with those of the Ciaglia Blue Rhino tracheostomy (CBR). We also compared the costs of mini-invasive tracheostomy with those of surgical tracheostomy (ST). Methods  Between January 1998 and January 2006, 530 patients needed emergency intubation and protracted assisted ventilation in our department. We performed 470 mini-invasive tracheostomies: as TLT in 350 and as CBR in 120. The time between intubation and tracheostomy was 4 ± 1 days. Interventions were carried out in our intensive care unit (ICU). Results  One hundred and nine patients died within 20 ± 5 days of intervention, but 361 are still alive after 100 ± 3 months. TLT and CBR complications were independent of the operative technique (P = 0.74, r = 0.285 vs P = 0.61, r = 0.271) or procedure time (P = 0.95, r = 0.297 vs P = 0.92, r = 0.295). Ciaglia Blue Rhino tracheostomy was noted to have a cost-benefit advantage over TLT and ST (P = 0.0002, P = 0.009, P = 0.22, respectively). The average time until decannulation was 20 ± 1 days. Conclusions  Mini-invasive tracheostomies are easy, safe, and fast. Ciaglia Blue Rhino tracheostomy took less time to perform and had fewer complications than TLT, because the technique was simpler.     

经皮气管切开术在神经外科病人中的应用

目的 介绍经皮气管切开术在神经外科的应用经验。方法 对42例神经外科病人采用导丝扩张钳法行经皮气管切开术。结果 41例成功，1例改行正规的气管切开术。手术时间平均8．5min。无严重并发症及与手术操作有关的死亡发生。结论 经皮气管切开术简单、快速、损伤小，可在神经外科广泛应用。     

Evaluation of a new technique for bedside percutaneous tracheostomy

BACKGROUND: Percutaneous tracheostomy as described by Ciaglia is accepted as a safe technique with minimal associated morbidity. Recent modification of the technique to a single-step dilator prompted us to evaluate this in the critically injured patient. METHODS: A comparison of patients undergoing percutaneous tracheostomy was performed. From May 1998 to May 1999, patients underwent surgery using the sequential multidilator technique (MDT), and from July 1999 to July 2000, patients underwent surgery using the single dilation technique (SDT). RESULTS: Ninety-three tracheostomies were performed, 49 MDT and 44 SDT. Time to tracheostomy and total ventilator days was similar between the groups. Three complications occurred. In the MDT group, 1 patient experienced delayed tracheal hemorrhage not requiring transfusion. In the SDT group, 1 patient had transient right lower lobe collapse, and another patient had unexplained extubation requiring emergent cricothyroidotomy. CONCLUSIONS: Percutaneous tracheostomy using the single-step Rhino dilator technique is technically easier than the currently accepted multidilator technique with equivalent complications.     

Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy

This trial prospectively compares two methods of percutaneous tracheostomy, both routinely used in ICU: the Ciaglia progressive dilational tracheostomy and the Griggs forceps dilational tracheostomy. One hundred patients were randomized using a single-blinded envelope method to receive progressive or forceps percutaneous tracheostomy performed at the bedside. Operative time, the occurrence of hypoxaemia or hypercapnia and complications were recorded. The progressive technique took longer than the forceps technique (median 7 (range 2-26) vs. 4 (1-16) minutes, P = 0.0005). Hypercapnia occurred in both groups but was more marked with the progressive technique (56 (16) vs. 49 (13) mmHg, P = 0.0082). Minor complications (minor bleeding, transient hypoxaemia, damage to posterior tracheal wall without emphysema) were also more frequent with the progressive technique (31 vs. 9 complications, P < 0.0001). Six major complications occurred with the progressive technique, none with the forceps technique (P = 0.0085): tension pneumothorax, posterior tracheal wall injury with subcutaneous emphysema, loss of airway with hypoxaemia, loss of stoma with impossible re-catheterization, and two conversions to another technique. In conclusion, progressive dilational tracheostomy took longer, caused more hypercapnia and more minor and major difficulties than forceps dilational tracheostomy.     

Iatrogenic aortic arch injury after unsuccessful percutaneous tracheostomy

Tracheostomy is a procedure that creates a direct opening to the airway through an incision in the anterior wall of the trachea. These days it is usually performed percutaneously as it is generally regarded as a safe procedure. We present the case of an unusual complication of aortic arch injury after percutaneous tracheostomy (PT) performed at an outside hospital. Major vascular injury was managed with sternotomy and direct aortic repair with a successful outcome. We believe PT should be performed under direct bronchoscopy visualization to limit any possible complications. Intensivists should be aware of this extremely rare complication of PT, which requires emergency cardiac surgery intervention and a team effort for appropriate management.