两种经皮气管切开应用于心外科术后患者的临床效果比较.doc

两种经皮气管切开术应用于心外科术后患者的临床效果比较 刘洋 李白翎 张本 周炜 郑艳华 徐志云* （第二军医大学长海医院胸心外科，上海 200433） [摘要] 目的 对比研究两种经皮气管切开术即经皮导丝扩张钳技术和经皮单步扩张气管切开在心外科术后患者中的临床效果。 方法 选取2011年10月至2013年8月行正中开胸心脏手术术后符合气管切开指征的患者60例，分为经皮导丝扩张钳技术组（GWDF组）和经皮单步扩张气管切开组（SSDT组），每组各30例，对两组的手术时间、扩张次数、出血量和手术并发症等进行比较。 结果 SSDT组操作时间明显短于GWDF组[（6.5±2.2）min vs （9.3±3.1），P=0.02]，SSDT组的扩张次数明显少于GWDF组[（1.10±0.05）次 vs (1.53±0.22)次， P=0.001]，SSDT组的手术出血量明显少于GWDF组(P=0.000)；GWDF组的总的严重并发症发生率明显高于SSDT组（P =0.000）。 结论 经皮单步扩张气管切开与导丝扩张钳技术相比操作方便、手术时间短、创伤小、成功率高、并发症少，是心脏术后危重患者气管切开的首选。 [关键词] 经皮气管切开术；导丝扩张钳技术；单步扩张气管切开 中图分类号：R655 文献标识：A 文章编号： Comparison of the Curative Effect Between Two Different Methods of Percutaneous Dilational Tracheostomy in Patients After Cardiac Surgery LIU Yang，LI Bai-ling，ZHANG Ben，ZHOU Wei, ZHENG Yan-hua, XU Zhi-yun. Division of Cardiothoracic Surgery，Changhai Hospital，Second Military Medical University，Shanghai 200433，China [abstract] Objective To compare the curative effect of two different methods of percutaneous tracheostomy , which were the guide wire dilating forceps (GWDF method ) and the single step dilational tracheostomy (SSDT). Methods A prospective study was conducted on 60 severe patients undergoing cardiosurgery (from October 2011 to August 2013). The patients were divided into GWDF group and SSDT group with 30 cases in each. The operation time, blood loss, and postoperative complications were compared between the two groups. Results The operation time in the SSDT group was significantly shorter than those in the GWDF group[（6.5 ± 2.2）min vs （9.3 ± 3.1），P = 0.02]P =0.000）. Conclusions The single step dilational tracheostomy has shorter operation time ,less invasive, higher success rate and fewer complications compared to the guide wire dilating forceps technique. It could be a first choice for severe patients after cardiosurgery. [Key words] Percutaneous dilational tracheostomy；Guide wire dilating forceps；Single step dilational tracheostomy； 经皮扩张气管切开（percutaneous dilational tracheostomy，PDT）在心脏外科正中开