Hart Catherine K, Tawfik Kareem O, Meinzen-Derr Jareen, Prosser John Drew, Brumbaugh Cheryl, Myer Amy, Ward Jonette A, de Alarcon Alessandro
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio.
Laryngoscope. 2017 Sep;127(9):1996-2001. doi: 10.1002/lary.26608. Epub 2017 May 7.
OBJECTIVES/HYPOTHESIS: Tracheotomy is a common procedure. A reliable method of securing the tracheotomy tube is essential to minimize accidental decannulation. However, skin breakdown has been reported in ∼30% of patients. We sought to evaluate rates of skin-related complications and accidental decannulation with the use of Velcro ties compared to twill ties.
A nonblinded, randomized controlled trial comparing Velcro versus twill ties in patients undergoing tracheotomy between July 1, 2014 and January 31, 2016.
Patients ≤21 years of age were recruited and randomized to receive either Velcro or twill ties. The primary outcome measure was skin-related complications. The secondary outcome measure was accidental decannulation. Outcome measures were followed through postoperative day 5.
Ninety-three patients were eligible, and 63 were enrolled. No patients were withdrawn. Fifty-seven patients were included in the analysis. Twenty-seven (47.4%) received Velcro, and 30 (52.6%) received twill. Five enrolled patients did not undergo tracheotomy (one Velcro, four twill). One was diagnosed with a genetic skin condition after enrollment but prior to undergoing tracheotomy. Patient characteristics were similar between groups. No significant differences were found with respect to skin-related complications (P = .59). Six patients (20%) with twill ties required early tie change compared to two (7.4%) with Velcro ties (P = .5). Two accidental decannulations occurred in the twill group compared to one in the Velcro group (P = 1.0).
Our study demonstrated no differences in skin-related complications or accidental decannulation between Velcro and twill tracheotomy ties in the immediate postoperative period following tracheotomy. Our study suggests that Velcro ties are a viable alternative to twill ties.
1b Laryngoscope, 127:1996-2001, 2017.
目的/假设：气管切开术是一种常见的手术。一种可靠的固定气管切开导管的方法对于将意外脱管的风险降至最低至关重要。然而，据报道约30%的患者会出现皮肤破损。我们试图评估与使用斜纹布系带相比，使用尼龙搭扣系带时皮肤相关并发症和意外脱管的发生率。
一项非盲、随机对照试验，比较2014年7月1日至2016年1月31日期间接受气管切开术患者使用尼龙搭扣系带与斜纹布系带的情况。
招募年龄≤21岁的患者，并随机分为接受尼龙搭扣系带或斜纹布系带两组。主要观察指标为皮肤相关并发症。次要观察指标为意外脱管。观察指标持续记录至术后第5天。
93例患者符合条件，63例患者入组。无患者退出。57例患者纳入分析。27例（47.4%）接受尼龙搭扣系带，30例（52.6%）接受斜纹布系带。5例入组患者未接受气管切开术（1例使用尼龙搭扣系带，4例使用斜纹布系带）。1例患者在入组后但在接受气管切开术前被诊断患有遗传性皮肤病。两组患者的特征相似。在皮肤相关并发症方面未发现显著差异（P = 0.59）。与2例（7.4%）使用尼龙搭扣系带的患者相比，6例（20%）使用斜纹布系带的患者需要提前更换系带（P = 0.5）。斜纹布组发生2例意外脱管，尼龙搭扣组发生1例（P = 1.0）。
我们的研究表明，在气管切开术后的即刻，尼龙搭扣系带与斜纹布系带在皮肤相关并发症或意外脱管方面没有差异。我们的研究表明，尼龙搭扣系带是斜纹布系带的一种可行替代方案。
1b 《喉镜》，127:1996 - 2001，2017年。
