Khalili Theodore M, Koss Wega, Margulies Daniel R, Morrison Esther, Shabot M Michael
Burns and Allen Research Institute, Department of Surgery, Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California 90048, USA.
Am Surg. 2002 Jan;68(1):92-4.
Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. OT was performed in the operating room whereas PDT was performed in intensive care units (ICUs). PDT was performed by surgeons and medical intensivists under a strict institutional policy and procedure governing patient selection and conduct of the procedure. Complications were defined as bleeding, loss of airway, hypotension, hypoxia, tracheostomy tube malposition, subcutaneous emphysema, infection, and conversion of PDT to OT. All patients survived the operation. PDT and OT had similar complication rates: 2.1 per cent for PDT versus 2.8 per cent for OT (P = not significant). Postoperative bleeding, which was the most frequent complication, occurred in one PDT patient and four OT patients. One PDT patient required conversion to OT as a result of extensive tracheal fibrosis. Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.
尽管经皮扩张气管切开术（PDT）已被提倡作为开放气管切开术（OT）的替代方法，但其相对安全性却屡屡受到质疑。本研究前瞻性地比较了PDT和OT的安全性及并发症情况。1998年12月至2000年4月期间，该机构有94例患者接受了PDT，252例患者接受了OT，手术方式由操作者选择。OT在手术室进行，而PDT在重症监护病房（ICU）进行。PDT由外科医生和内科重症监护医生在严格的机构政策和程序下进行，该政策和程序规定了患者选择和手术操作。并发症定义为出血、气道丧失、低血压、低氧血症、气管切开管位置异常、皮下气肿、感染以及PDT转为OT。所有患者均存活至手术结束。PDT和OT的并发症发生率相似：PDT为2.1%，OT为2.8%（P值无统计学意义）。术后出血是最常见的并发症，1例PDT患者和4例OT患者发生了术后出血。1例PDT患者因广泛气管纤维化而需要转为OT。皮下气肿、软组织感染和气管切开管位置异常是OT患者的其他并发症。我们得出结论，PDT和OT的并发症发生率相当。PDT或OT的选择应由外科医生的培训和经验、患者状况、颈部解剖结构以及转至手术室的稳定性来决定。
