经皮扩张气管切开术在ICU中的应用研究

目的评价经皮扩张气管切开术（PDT）在重症监护病房（ICU）危重症患者人工气道建立中的应用价值。方法将46例收住ICU的危重症患者随机分为两组。PDT组23例实施PDT建立人工气道,对照组23例实施传统开放式气管切开术（OT）。比较两组镇静剂用量、手术操作时间、切口大小、出血量、切口愈合时间、疤痕大小、手术过程中患者生命体征变化、手术相关并发症发生率。结果 PDT组和对照组丙泊酚用量分别为（45.88±14.53）mg和（117.18±22.55）mg,手术时间分别为（9.66±3.25）min和（17.63±3.86）min,术中出血量分别为（5.17±2.41）ml和（14.18±3.61）ml,切口大小分别为（1.52±0.38）cm和（3.72±0.27）cm,切口愈合时间分别为（3.87±0.32）d和（6.63±1.15）d,手术疤痕大小分别为（0.26±0.04）cm2和（1.39±0.26）cm2,两组比较差异有统计学意义（P〈0.01或0.05）;手术前监测PDT组和对照组患者平均动脉压（MAP）分别为（77.44±3.17）mmHg（1mmHg=0.133kPa）和（76.15±3.86）mmHg,心率（HR）分别为（81.67±5.37）次/min和（80.69±4.82）次/min,SpO2分别为（97.92±1.76）%和（97.83±1.86）%,两组比较差异均无统计学意义;术中监测MAP分别为（82.81±4.20）mmHg和（88.63±8.96）mmHg,HR分别为（85.35±7.77）次/min和（92.17±12.23）次/min,SpO2分别为（95.22±2.73）%和（91.38±3.67）%,两组比较差异有统计学意义（P〈0.05）;PDT组和对照组患者手术前后MAP变化值分别为（5.37±1.18）mmHg和（12.48±4.52）mmHg,HR变化值分别为（3.68±2.03）次/min和（11.48±6.02）次/min,SpO2变化值分别为（2.70±0.89）%和（6.45±1.63）%,两组比较差异有统计学意义（P〈0.05）。PDT组术后并发症发生率明显小于对照组（χ2=8.1778,P〈0.01）。结论 PDT是一种安全、有效、快捷的微创急救技术,值得在ICU推广应用。

Clinical Application of Percutaneous Dilation Tracheostomy in Intensive Care Units

Objective To explore the clinical application of percutaneous dilation tracheostomy（PDT）in ICU patients.Methods 46 ICU patients were randomly divided into PDT group（n=23）and open tracheotomy（OT）group（n=23）.The doses of propofol,the operating time,the incision size,the amount of bleeding,the healing time,the scar size,the vital signs and complications were observed between the two groups.Results Between the PDT group and the OT group,the doses of propofol were（45.88±14.53）mg and（117.18±22.55）mg,the operating time was（9.66±3.25）min and（17.63±3.86）min,the amount of bleeding was（5.17±2.41）ml and（14.18±3.61）ml,the incision size was（1.52±0.38）cm and（3.72±0.27）cm,the healing time was（3.87±0.32）d and（6.63±1.15）d,the scar size was（0.26±0.04）cm2 and（1.39±0.26）cm2.There were significant differences between the two groups（P〈0.01 or 0.05）.Between the PDT group and the OT group,MAP before the operation were（77.44±3.17）mm Hg and（76.15±3.86）mm Hg,HR were（81.67±5.37）times/min and（80.69±4.82）times/min,SpO2 were（97.92±1.76）% and（97.83±1.86）%.There were no significant differences between the two groups.Between the PDT group and the OT group,MAP during the operation were（82.81±4.20）mm Hg and（88.63±8.96）mm Hg,HR were（85.35±7.77）times/min and（92.17±12.23）times/min,SpO2 were（95.22±2.73）% and（91.38±3.67）%.There were significant differences between the two groups（P〈0.05）.Between the PDT group and the OT group,the variations of MAP before and after the operation were（5.37±1.18）mm Hg and（12.48±4.52）mm Hg,HR were（3.68±2.03）times/min and（11.48±6.02）times/min,SpO2 were（2.70±0.89）% and（6.45±1.63）%.There were significant differences between the two groups（P〈0.05）.There were fewer complications in PDT group than in OT group（χ^2=8.1778,P〈0.01）.Conclusion PDT was worth of clinical application in ICU,because it＇s safe,practical,simple and rapid.