Deppe Antje-Christin, Kuhn Elmar, Scherner Maximilian, Slottosch Ingo, Liakopoulos Oliver, Langebartels Georg, Choi Yeong-Hoon, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
Thorac Cardiovasc Surg. 2013 Apr;61(3):234-9. doi: 10.1055/s-0032-1322608. Epub 2013 Jan 23.
Percutaneous dilatational tracheotomy (PDT) is a common procedure. Coagulation disorders represent a relative contraindication for PDT and, therefore, normalization of hemostasis parameters is recommended. Especially patients undergoing cardiac surgery after valve replacement and with any kind of assist device need to require an adequate anticoagulation. This study investigated the impact of impaired hemostasis as a risk factor for bleeding complications retrospectively.
Patients who underwent PDT (November 2007 to November 2010) were stratified into a high-risk (HR) and low-risk (LR) group in regard to bleeding complications. The following determining factors activated partial thromboplastin time (aPTT > 50 seconds, prothrombin time (PT < 50%), international normalized ratio (INR > 1.4), and platelet count (< 50,000/µL) were assessed.
A total of 213 patients underwent PDT (HR = 5/85; LR = 8/128). There was no difference in demographics or intraoperative data. Patients of both groups showed mild bleeding without the need for surgical intervention or transfusion (p = 0.957). There were no severe bleeding nor other procedure-related complications.
Percutaneous tracheotomy is a safe and feasible procedure in patients with coagulation disorders. Therefore, discontinuation of anticoagulation treatment or normalization of hemostasis prior to the procedure is not necessary.
经皮扩张气管切开术（PDT）是一种常见的手术。凝血功能障碍是PDT的相对禁忌证，因此建议使止血参数正常化。尤其是接受瓣膜置换术后心脏手术且使用任何辅助装置的患者需要进行充分的抗凝治疗。本研究回顾性调查了止血功能受损作为出血并发症危险因素的影响。
将2007年11月至2010年11月接受PDT的患者根据出血并发症分为高危（HR）组和低危（LR）组。评估以下决定因素：活化部分凝血活酶时间（aPTT>50秒）、凝血酶原时间（PT<50%）、国际标准化比值（INR>1.4）和血小板计数（<50,000/µL）。
共有213例患者接受了PDT（HR组5/85；LR组8/128）。两组患者在人口统计学或术中数据方面无差异。两组患者均有轻度出血，无需手术干预或输血（p=0.957）。没有严重出血或其他与手术相关的并发症。
经皮气管切开术对于凝血功能障碍患者是一种安全可行的手术。因此，术前无需停用抗凝治疗或使止血功能正常化。
