Añón J M, Escuela M P, Gómez V, Moreno A, López J, Díaz R, Montejo J C, Sirgo G, Hernández G, Martínez R
Department of Intensive Care Medicine, Hospital Virgen de la Luz, Cuenca, Clínica Moncloa, Madrid, Spain.
Acta Anaesthesiol Scand. 2004 Apr;48(4):451-6. doi: 10.1111/j.1399-6576.2004.0313.x.
Percutaneous tracheostomy (PT) has gained widespread acceptance to control the airway in patients requiring prolonged mechanical ventilation. Since 1985, new techniques for PT have been described. It was the aim of this investigation to compare two different PT techniques: the Ciaglia Blue Rhino (CBR) and the Guide Wire Dilating Forceps (GWDF).
A prospective randomized trial was performed in four intensive care units. After informed consent, 53 consecutive patients were randomized to undergo CBR or GWDF. Procedural complications were evaluated and specific symptoms of the upper airway tract in survivors were assessed.
Twenty-seven patients were randomly assigned to CBR and 26 to GWDF. Patients mean ages were 62.7 +/- 15.8 years and 62.2 +/- 18.3, respectively. Mean APACHE II scores were 20.6 +/- 6.8 and 21.2 +/- 7.2, respectively. Median duration of the procedure was 7 min (range: 4-17 min) with GWDF and 9 min (range: 5-32 min) with CBR (P = 0.16). Seven patients in the group undergoing GWDF had complications (desaturation: two; mild bleeding: one; infected stoma: one; inability to complete the procedure: three). Two patients had complications in the group undergoing CBR (mild bleeding) (P = 0.07). Survivors were followed up after discharge. Three patients (all of them having undergone GWDF) were symptomatic (two with mild hoarseness and one with a persistent foreign body sensation), but laryngotracheoscopy was negative.
Our results show no differences between both techniques regarding surgical duration or procedural complications. Late symptoms were encountered in three patients undergoing GWDF, however, laryngotracheoscopy failed to document anatomical or functional abnormalities.
经皮气管切开术（PT）已被广泛接受，用于需要长期机械通气患者的气道管理。自1985年以来，已有多种PT新技术被描述。本研究旨在比较两种不同的PT技术：Ciaglia蓝犀牛技术（CBR）和导丝扩张钳技术（GWDF）。
在四个重症监护病房进行了一项前瞻性随机试验。在获得知情同意后，连续53例患者被随机分配接受CBR或GWDF治疗。评估手术并发症，并对幸存者的上呼吸道特定症状进行评估。
27例患者被随机分配至CBR组，26例至GWDF组。患者的平均年龄分别为62.7±15.8岁和62.2±18.3岁。平均急性生理与慢性健康状况评分系统II（APACHE II）评分分别为20.6±6.8和21.2±7.2。GWDF组手术的中位持续时间为7分钟（范围：4 - 17分钟），CBR组为9分钟（范围：5 - 32分钟）（P = 0.16）。GWDF组有7例患者出现并发症（血氧饱和度下降：2例；轻度出血：1例；造口感染：1例；无法完成手术：3例）。CBR组有2例患者出现并发症（轻度出血）（P = 0.07）。对幸存者出院后进行随访。3例患者（均接受GWDF治疗）有症状（2例轻度声音嘶哑，1例有持续异物感），但喉镜检查结果为阴性。
我们的结果显示，两种技术在手术持续时间或手术并发症方面无差异。接受GWDF治疗的3例患者出现了晚期症状，然而，喉镜检查未发现解剖或功能异常。
