Gao Yang, Liu Yang, Tang Rong, Liu Haitao, Zhang Xing, Yu Kaijiang
Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang, China. Corresponding author: Yu Kaijiang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Feb;26(2):106-9. doi: 10.3760/cma.j.issn.2095-4352.2014.02.010.
To investigate the application of modified percutaneous dilative tracheostomy (MPDT) in critical patients of intensive care unit (ICU).
The clinical data of 143 critically ill patients experienced tracheostomy in intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. There were 55 cases in MPDT group, 41 in percutaneous dilative tracheostomy (PDT) group, and 47 in conventional surgical tracheostomy (ST) group. The operation information such as operation time, blood loss and the incidence of complications were observed among three groups.
The operation time (7.2 ± 1.9 minutes, 6.9 ± 2.1 minutes), amount of blood loss (6.9 ± 2.7 mL, 8.0 ± 3.2 mL), size of operative incision (1.2 ± 1.1 cm, 1.3 ± 0.9 cm) and incision healing time (7.5 ± 2.0 days, 6.7 ± 1.9 days) in MPDT group and PDT group were superior to ST group (23.1 ± 4.5 minutes, 26.3 ± 3.8 mL, 2.8 ± 1.2 cm, 10.1 ± 2.1 days, respectively) with statistical significances (all P<0.05) but there was no significant difference in above indexes between MPDT group and PDT group. The incidences of perioperative and postoperative complications in MPDT group and PDT group were significantly lower than those in ST group [perioperative period: 23.64% (13/55), 41.46% (17/41) vs. 55.32% (26/47); postoperative period: 18.18% (10/55), 31.71% (13/41) vs. 55.32% (26/47)] with statistical significances (all P<0.05). There was no tracheal wall injury or perforation and tracheoesophageal fistula in MPDT group, while there were 5 tracheal wall injuries, 5 perforations, and 5 tracheoesophageal fistulas in PDT group.
MPDT which is more effective, safe, simple and with minor injury than ST, is able to avoiding tracheal wall injury or perforation and tracheoesophageal fistula and is very suitable for patients in ICU.
探讨改良经皮扩张气管切开术（MPDT）在重症监护病房（ICU）重症患者中的应用。
回顾性分析哈尔滨医科大学附属第二医院重症监护病房（ICU）143例行气管切开术的重症患者的临床资料。MPDT组55例，经皮扩张气管切开术（PDT）组41例，传统外科气管切开术（ST）组47例。观察三组的手术时间、出血量及并发症发生率等手术相关信息。
MPDT组和PDT组的手术时间（7.2±1.9分钟，6.9±2.1分钟）、出血量（6.9±2.7毫升，8.0±3.2毫升）、手术切口大小（1.2±1.1厘米，1.3±0.9厘米）及切口愈合时间（7.5±2.0天，6.7±1.9天）均优于ST组（分别为23.1±4.5分钟，26.3±3.8毫升，2.8±1.2厘米，10.1±2.1天），差异有统计学意义（均P<0.05），但MPDT组与PDT组上述指标比较差异无统计学意义。MPDT组和PDT组围手术期及术后并发症发生率均显著低于ST组[围手术期：23.64%（13/55），41.46%（17/41）对55.32%（26/47）；术后：18.18%（10/55），31.71%（13/41）对55.32%（26/47）]，差异有统计学意义（均P<0.05）。MPDT组未发生气管壁损伤或穿孔及气管食管瘘，而PDT组发生5例气管壁损伤、5例穿孔及5例气管食管瘘。
MPDT较ST更有效、安全、简便、创伤小，能避免气管壁损伤或穿孔及气管食管瘘，非常适合ICU患者。
