经皮扩张气管切开术在危重症SARS患者抢救中降低术者感染的探讨

目的 比较传统开放性气管切开术(open tracheostomy，OT)与经皮扩张气管切开术(percutaneous dilational tracheostomy，PDT)在严重急性呼吸综合征(SARS)患者抢救中能否降低术者的感染机会。方法 通过回顾性分析2003年4～7月间实施气管切开患者PDT5例、OT3例，比较两种方法在SARS危重患者中的手术操作时间，观察术后气管切开处漏痰情况。结果 8例手术均顺利完成，且无操作者感染SARS，PDT平均操作时间12min，最快建立气道7min；OT平均操作时间38．7min，最快建立气道31min；PDT5例患者术后气管切开处均无明显漏痰现象；OT3例患者术后气管切开处于术后1、3、5、7d均有漏痰现象。结论 PDT作为一项微创手术与OT比较手术操作简单，较OT手术操作时间明显缩短，显著减少了操作者近距离暴露于SARS患者面前的时间，且伤口出血少，无明显漏痰现象，减少了污染环境的机会，理论上讲可相对减少医护人员受感染机会，在需要做气管切开的SARS危重患者中如无禁忌应采用PDT。

The Application Value of PDT in Critical Treatment for SARS

OBJECTIVE To compare the infection of the open tracheostomy (OT) and the percutaneous dilational tracheostomy (PDT) in critical treatment for severe acute respiratory syndrome (SARS). METHODS By means of analysis of 5 cases of PDT and 3 cases of OT treatment from Apr to Jul 2003 to compare the operating time and the perioperative complication. Meanwhile the leakage of sputum from operation area was monitored. RESULTS Eight cases were successfully operated and no infection occurred. The average operating time of PDT was 12 minutes. The shortest time to set up the airway was 7 minutes. The average operating time of OT was 38.7 minutes and the shortest time to set up airway was 31 minutes. There was no obvious leakage of sputum in the 5 PDT patients. In opposition, leakage of sputum was observed in OT treatment patients.CONCLUSIONS As a minimally invasive operation, PDT is easy to operate in comparison to OT. PDT greatly shortens the operating time and reduce the infection opportunity to medicare personnel.