Takahashi Mitsuko, Itagaki Shinobu, Laskaris Jessica, Filsoufi Farzan, Reddy Ramachandra C
From the *Park Cardiothoracic & Vascular Institute, Jefferson Borough, PA USA; and †Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY USA.
Innovations (Phila). 2014 Jan-Feb;9(1):22-6. doi: 10.1097/IMI.0000000000000041.
It is a common situation after cardiothoracic surgery that a tracheostomy is required for patients who are coagulopathic or on therapeutic anticoagulation. We present our results of percutaneous tracheostomy with uncorrected coagulopathy.
Between 2007 and 2012, a total of 149 patients in our Cardiothoracic Surgical Intensive Care Unit underwent percutaneous tracheostomy using the Ciaglia Blue Rhino system (Cook Medical, Bloomington, IN USA). The patients were divided into coagulopathic (platelets, ≤50,000; international normalized ratio of prothrombin time, ≥1.5; and/or partial thromboplastin time, ≥50) and noncoagulopathic groups. Coagulopathy, if present before percutaneous tracheostomy, was not routinely corrected.
A total of 75 patients (49%) were coagulopathic. Twenty-one patients (14%) had two or more criteria. The coagulopathic patients had a lower platelet count [108 (106) vs 193 (111) (thousands), P < 0.001], with the lowest of 10; higher international normalized ratio of prothrombin time [1.7 (0.6) vs 1.2 (0.1), P < 0.001], with the highest of 5.3; longer partial thromboplastin time [40 (13) vs 33 (7) seconds, P < 0.001], with the longest of 85; and higher total bilirubin [4.6 (7.3) vs 1.9 (3.3) mg/dL, P = 0.005]. Patient demographics and comorbidities were comparable between the groups. No patients had overt bleeding. One coagulopathic patient (1.3%) had clinical oozing treated with packing, as opposed to zero in the noncoagulopathic patients (P = 1.00). There were no patients with posttracheostomy mediastinitis or late tracheal stenosis.
Uncorrected coagulopathy and therapeutic anticoagulation did not increase bleeding risk for percutaneous tracheostomy in our cardiothoracic surgical patients.
心胸外科手术后，对于存在凝血功能障碍或接受治疗性抗凝的患者，需要进行气管切开术是一种常见情况。我们展示了对未纠正凝血功能障碍患者进行经皮气管切开术的结果。
2007年至2012年期间，我们心胸外科重症监护病房共有149例患者使用Ciaglia Blue Rhino系统（美国印第安纳州布卢明顿市库克医疗公司）进行了经皮气管切开术。患者被分为凝血功能障碍组（血小板≤50,000；凝血酶原时间国际标准化比值≥1.5；和/或活化部分凝血活酶时间≥50）和非凝血功能障碍组。如果在经皮气管切开术前存在凝血功能障碍，则不常规进行纠正。
共有75例患者（49%）存在凝血功能障碍。21例患者（14%）有两项或更多标准。凝血功能障碍患者的血小板计数较低[108（106）对193（111）（千），P<0.001]，最低为10；凝血酶原时间国际标准化比值较高[1.7（0.6）对1.2（0.1），P<0.001]，最高为5.3；活化部分凝血活酶时间较长[40（13）对33（7）秒，P<0.001]，最长为85；总胆红素较高[4.6（7.3）对1.9（3.3）mg/dL，P = 0.005]。两组患者的人口统计学和合并症情况具有可比性。没有患者出现明显出血。1例凝血功能障碍患者（1.3%）出现临床渗血，经填塞处理，而非凝血功能障碍患者中无此情况（P = 1.00）。没有患者发生气管切开术后纵隔炎或晚期气管狭窄。
在我们的心胸外科患者中，未纠正的凝血功能障碍和治疗性抗凝并未增加经皮气管切开术的出血风险。
