Al Dawood Abdulaziz, Haddad Sameer, Arabi Yaseen, Dabbagh Ousama, Cook Deborah J
Intensive Care Dept, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Middle East J Anaesthesiol. 2007 Feb;19(1):37-49.
The safety and complications of percutaneous tracheostomy (PT) without bronchoscopic guidance in a group of ICU patients with thrombocytopenia platelet count of < or = 60.000/mm3) or coagulopathy (INR > or = 1.5 or systemic heparinization), was studied. During the study period (May 2004-June 2005), 190 percutaneous tracheostomies were performed. Of these there were 11 (6%) patients with prolonged INR, 7 (4%) patients with thrombocytopenia and 14 (7%) patients on systemic heparin. There was no evidence of bleeding in patients with prolonged INR. A minor bleeding developed in only one patient with thrombocytopenia, and in two patients receiving systemic heparin. The PT was aborted for one patient with thrombocytopenia and slight increase of INR (1.3) due to major bleeding in spite of transfusion of both platelets and FFP. Our data suggest the incidence of bleeding is low in patients with coagulopathy and or thrombocytopenia-undergoing PT without bronchoscopic guidance.
对一组血小板减少（血小板计数≤60,000/mm³）或凝血功能障碍（国际标准化比值≥1.5或全身肝素化）的重症监护病房患者，在无支气管镜引导下进行经皮气管切开术（PT）的安全性及并发症进行了研究。在研究期间（2004年5月至2005年6月），共进行了190例经皮气管切开术。其中，11例（6%）患者国际标准化比值延长，7例（4%）患者血小板减少，14例（7%）患者接受全身肝素治疗。国际标准化比值延长的患者未出现出血迹象。仅1例血小板减少患者及2例接受全身肝素治疗的患者出现轻微出血。1例血小板减少且国际标准化比值轻度升高（1.3）的患者尽管输注了血小板和新鲜冰冻血浆，但因大出血导致经皮气管切开术中止。我们的数据表明，在无支气管镜引导下接受经皮气管切开术的凝血功能障碍和/或血小板减少患者中，出血发生率较低。
