Añón J M, Gómez V, Escuela M P, De Paz V, Solana L F, De La Casa R M, Pérez J C, Zeballos E, Navarro L
Hospital Virgen de la Luz, Cuenca, Spain.
Crit Care. 2000;4(2):124-8. doi: 10.1186/cc667. Epub 2000 Mar 3.
Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpose of the present study was to compare two bedside percutaneous tracheostomy techniques: percutaneous dilatational tracheostomy (PDT) and the guidewire dilating forceps (GWDF).
A prospective study in two medical/surgical intensive care units (ICUs) was carried out. Sixty-three critically ill patients who required endotracheal intubation for longer than 15 days were consecutively selected to undergo PDT (25 patients) or GWDF (38 patients) technique. Intraoperative and postoperative complications were recorded.
Age (mean +/- standard error) was 63 +/- 1.1 years. The patients had been mechanically ventilated for an average of 19.8 +/- 1.2 days. The GWDF technique was significantly faster than PDT technique (P = 0.02). Fifteen complications occurred in 10 out of 63 (15%) patients. They were as follows: tracheal tear (one patient in each group; in one case this was due to false passage); transient hypotension (one patient in the PDT group and two patients in the GWDF group); atelectasis (one patient in the PDT group); and haemorrhage (one patient in the PDT group and three patients in the GWDF group). In both patients with tracheal tear, reduced arterial oxygen saturation (SaO2) with concomitant subcutaneous emphysema ensued.
We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT.
尽管杰克逊于1909年描述的标准气管切开术已在重症患者中广泛应用，但仍需要一种能在床边实施的更简单的手术方法。自1957年以来，已描述了几种不同类型的经皮气管切开术技术。本研究的目的是比较两种床边经皮气管切开术技术：经皮扩张气管切开术（PDT）和导丝扩张钳（GWDF）。
在两个内科/外科重症监护病房（ICU）进行了一项前瞻性研究。连续选择63例需要气管插管超过15天的重症患者，分别接受PDT技术（25例患者）或GWDF技术（38例患者）。记录术中及术后并发症。
年龄（均值±标准误）为63±1.1岁。患者平均机械通气时间为19.8±1.2天。GWDF技术明显比PDT技术快（P = 0.02）。63例患者中有10例（15%）出现了15种并发症。具体如下：气管撕裂（每组各1例患者；其中1例是由于穿刺误入假道）；短暂性低血压（PDT组1例患者，GWDF组2例患者）；肺不张（PDT组1例患者）；以及出血（PDT组1例患者，GWDF组3例患者）。在两例气管撕裂患者中，均出现了动脉血氧饱和度（SaO2）降低并伴有皮下气肿。
我们发现两种技术在并发症方面无统计学差异。GWDF技术所需的手术时间比PDT技术少。
