Liao Lillian, Myers John, Johnston Joe, Corneille Michael, Danielson Daren, Dent Daniel, Stewart Ronald, Pruitt Basil, Root H David, Cohn Stephen
Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Am J Surg. 2005 Dec;190(6):923-6. doi: 10.1016/j.amjsurg.2005.08.021.
A retrospective review of our experience with percutaneous tracheostomy was performed to determine our complication rate and pattern of use since this modality was introduced at our institution.
A retrospective chart review captured all patients in whom tracheostomy was performed or supervised by a trauma/critical care faculty member. Dates of hospital admission, ICU admission, intubation, discontinuation of mechanical ventilation, type and location of procedure, procedural complications, Injury Severity Score, charges, and patient demographics were collected. Percutaneous tracheostomy (PT) and open tracheostomy (OT) experiences were compared.
Three hundred sixty-eight tracheostomies were performed (190 OT and 178 PT). The average time to tracheostomy (TTT) for PT patients decreased from 12.7 to 7.4 days. The average TTT for OT patients remained stable at 14.0 days. The complication rate was 3.5%, with 4 complications (1.5%) associated with OT and 9 complications (5.1%) associated with PT. All complications in the PT group occurred before using a single dilator system. The 9 complications in the PT group occurred among 5 surgeons, all before their 11th attempt. PT saves 444 dollars in charges per procedure.
OT continues to be a safe method of performing tracheostomies. PT has a steep learning curve but can be mastered quickly. Benefits include a shorter time to tracheostomy, elimination of patient transport, and saving in charges. Initial PT attempts should be supervised by an experienced surgeon.
自经皮气管切开术在我院开展以来，我们对其进行了回顾性研究，以确定并发症发生率及使用模式。
通过回顾性病历审查，纳入所有由创伤/重症监护专业人员实施或监督气管切开术的患者。收集患者的入院日期、重症监护病房（ICU）入住日期、插管日期、机械通气停止日期、手术类型及部位、手术并发症、损伤严重程度评分、费用及患者人口统计学资料。对经皮气管切开术（PT）和开放性气管切开术（OT）的情况进行比较。
共实施了368例气管切开术（190例OT和178例PT）。PT患者气管切开的平均时间（TTT）从12.7天降至7.4天。OT患者的平均TTT保持稳定，为14.0天。并发症发生率为3.5%，其中OT相关并发症4例（1.5%），PT相关并发症9例（5.1%）。PT组所有并发症均发生在使用单一扩张器系统之前。PT组的9例并发症发生在5位外科医生中，均在他们第11次尝试之前。PT每次手术可节省444美元费用。
OT仍然是一种安全的气管切开术方法。PT学习曲线较陡，但可快速掌握。其优点包括气管切开时间缩短、无需转运患者及节省费用。初次进行PT尝试时应由经验丰富的外科医生监督。
