在创伤患者中，开放性气管切开术和经皮气管切开术后总体并发症及症状性气管狭窄的发生率相当。

Incidence of overall complications and symptomatic tracheal stenosis is equivalent following open and percutaneous tracheostomy in the trauma patient.

作者信息

Kettunen William W, Helmer Stephen D, Haan James M

机构信息

Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis Street, Room 3082, Wichita, KS 67214, USA.

Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis Street, Room 3082, Wichita, KS 67214, USA; Department of Trauma Services, Via Christi Hospital, Saint Francis Campus, Wichita, KS, USA.

出版信息

Am J Surg. 2014 Nov;208(5):770-774. doi: 10.1016/j.amjsurg.2013.12.036. Epub 2014 Apr 16.

DOI:10.1016/j.amjsurg.2013.12.036

PMID:24881020

Abstract

BACKGROUND

While percutaneous tracheostomy (PT) is becoming the procedure of choice for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT).

METHODS

A 10-year review was conducted of trauma patients undergoing tracheostomy. Data on demographics, injury severity, tracheostomy type, complications, and outcomes were compared between patients receiving PT or OT and for those with or without tracheal stenosis.

RESULTS

Of 616 patients, 265 underwent OT and 351 underwent PT. Median injury severity score was higher for PT (26 vs 24, P = .010). Overall complication rate was not different (PT = 2.3% vs OT = 2.6%, P = .773). There were 9 tracheal stenosis, 4 (1.1%) from the PT group and 5 (1.9%) from the OT group (P = .509). Mortality was higher in OT patients (15.5% vs 9.7%, P = .030). Patients developing tracheal stenosis were younger (29.8 vs 45.2 years, P = .021) and had a longer intensive care unit length of stay (28.3 vs 18.9 days, P = .036).

CONCLUSION

Risk of tracheal stenosis should not impact the decision to perform an OT or PT.

摘要

背景

虽然经皮气管切开术（PT）正成为择期气管切开术的首选术式，但关于其晚期并发症的数据较少。本研究比较了PT或开放性气管切开术（OT）后气管狭窄的发生率及相关因素。

方法

对接受气管切开术的创伤患者进行了为期10年的回顾性研究。比较了接受PT或OT的患者以及有或无气管狭窄患者的人口统计学、损伤严重程度、气管切开术类型、并发症及预后的数据。

结果

616例患者中，265例行OT，351例行PT。PT组的损伤严重程度评分中位数更高（26对24，P = 0.010）。总体并发症发生率无差异（PT = 2.3%对OT = 2.6%，P = 0.773）。有9例发生气管狭窄，PT组4例（1.1%），OT组5例（1.9%）（P = 0.509）。OT患者的死亡率更高（15.5%对9.7%，P = 0.030）。发生气管狭窄的患者更年轻（29.8岁对45.2岁，P = 0.021），重症监护病房住院时间更长（28.3天对18.9天，P = 0.036）。