深靜脈穿刺包聯合擴張鉗改良經皮擴張氣管切開術式的臨床應用觀察

摘要：目的 評價深靜脈穿刺包聯合擴張鉗改良經皮擴張氣管切開術式的臨床應用價值。方法 回顧性分析宣城市人民醫院重癥醫學科36例行氣管切開患者的臨床資料，其中試驗組18例，對照組18例。比較兩組間切口大小、手術時間等手術情況以及各種相關并發癥的發生率。結果 ①兩組患者切口大小、手術時間、術中出血比較，差異均無統計學意義（P>0.05）；而試驗組患者的手術費用明顯低于對照組，差異有統計學意義（P<0.05）。②兩組患者術后滲血量、低氧血癥、支氣管痙攣、皮下氣腫、心律失常發生率比較，差異均無統計學意義（P>0.05）。③兩組患者切口感染、氣管軟化、氣管狹窄發生率比較，差異均無統計學意義（P>0.05）。結論 深靜脈穿刺包聯合擴張鉗改良經皮擴張氣管切開術式值得推廣。

關鍵詞：深靜脈穿刺包；擴張鉗；改良經皮擴張氣管切開術

Clinical Application Observation of the Modified Pereutaneous Dilative Tracheostomy with Deep Venous Catheter Package Joint Spreading Forceps

WEI Ji-hong， TANG Yu-zhen， ZHANG Guo-hu， WU Zong-hui， MEI Hai-xia， XU Yuan-ping， DING Hui-qiang

（Department of Intensive Care Medicine， The People's Hospital of Xuancheng City， Xuancheng 242000，Anhui，China）

Abstract：Objective To evaluate the clinical application value of the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps. Methods The clinical data of 36 patients experienced tracheostomy in intensive care unit（ICU）of the People's Hospital of Xuancheng City were retrospectively analyzed. There were 18 cases in test group and 18 cases in control group. The operation information such as incision size， operation time， blood loss and the incidence of various related complications were observed among two groups. Results ①The incision size， operation time， and blood loss showed no statistically significant difference between the two groups（P>0.05）， but the cost of test group was significantly lower than the control group（P<0.01）. ②The post-operational blood loss and the incidence of hyoxemia， bronchospasm， pneumoderm， arrhythmia showed no statistically significant difference between the two groups（P>0.05）. ③The incidence of incision infection， tracheomalacia， tracheostenosis showed no statistically significant difference between the two groups（P>0.05）. Conclusion It is worth to generalize the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps.

Key words：Deep venous catheter package；Spreading forceps； Modified pereutaneous dilative tracheostomy

氣管切開是危重患者建立人工氣道的常用方法，但常規氣管切開手術存在組織損傷大、手術耗時長、術中患者耐受性差、術中長時間缺氧及并發癥多（如大出血、氣胸、氣道狹窄、心跳呼吸驟停等）等缺點，為此，Shelden[1]等提出經皮擴張氣管切開術（percutaneous dilational tracheostomy，PDT），自1985年Ciaglia等[2]改進了經皮擴張氣管切開術后的20余年來，因其操作簡單、迅速、并發癥少，而在重癥醫學科逐漸開展。我院在2012年采用Smiths公司生產的Portex一次性微創氣管切開器械也開展了該項技術，使用中發現采用其原裝耗材昂貴不利于類似我院的三線及以下城市的臨床推廣。為次我科于2013年對原操作方案予以改良，采用深靜脈包聯合擴張鉗操作，獲得了更好的價效及時效比，現報道如下。……