Hinerman R, Alvarez F, Keller C A
Division of Pulmonary, Critical Care, and Occupational Medicine, St Louis University Medical School, St Louis University Hospital, MO 63110, USA.
Intensive Care Med. 2000 Dec;26(12):1850-6. doi: 10.1007/s001340000718.
To determine the morbidity and mortality of percutaneous dilational tracheostomy with bronchoscopic guidance when performed by medical intensivists.
A retrospective analysis.
A tertiary care university hospital.
Fifty consecutive patients who underwent percutaneous dilational tracheostomy for prolonged mechanical ventilation.
Bedside percutaneous dilational tracheostomy with bronchoscopic guidance.
Seventeen women and 33 men with a mean age of 62 +/- 17 years. Operative mortality was 0 with four (8%) operative complications. Complications included one posterior tracheal abrasion, one anterior tracheal laceration, one episode of endobronchial hemorrhage requiring bronchoscopy, and one pneumothorax. Thirty-day mortality was 28% and overall mortality was 40%. All deaths were related to the patients' underlying disease.
Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications.
确定由医学重症监护医师在支气管镜引导下进行经皮扩张气管切开术的发病率和死亡率。
回顾性分析。
一家三级护理大学医院。
连续50例因长期机械通气而接受经皮扩张气管切开术的患者。
在支气管镜引导下进行床边经皮扩张气管切开术。
17名女性和33名男性，平均年龄62±17岁。手术死亡率为0，有4例（8%）手术并发症。并发症包括1例气管后壁擦伤、1例气管前壁撕裂、1例需要支气管镜检查的支气管内出血和1例气胸。30天死亡率为28%，总死亡率为40%。所有死亡均与患者的基础疾病有关。
在三级护理机构中，由经验丰富的医学重症监护人员在支气管镜引导下进行经皮扩张气管切开术是一种安全的手术。支气管镜有助于降低主要并发症的风险，并有助于处理轻微并发症。
