Nikbakhsh Novin, Amri Fatemeh, Monadi Mahmood, Amri Parviz, Bijani Ali
Department of Surgery, Babol University of Medical Sciences, Babol, Iran.
Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2021 Apr;12(3):249-255. doi: 10.22088/cjim.12.3.249.
Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure in the ICU. The present study was conducted to compare semi-surgical percutaneous dilatational tracheostomy (SSPDT) with conventional percutaneous dilatational tracheostomy (CPDT).
The present randomized clinical trial was conducted on 160 patients hospitalized in the medical intensive care units (ICUs) with an indication for tracheostomy and were systematically divided into two equal groups of 80. In the CPDT group, after a small incision, a 16-gauge needle was blindly inserted into the trachea and the guidewire was placed inside the lumen. A stoma was created by passing a single dilator over the guidewire. In the SSPDT group, a transverse incision (2 cm) was made 1 cm below the cricoid, and the tracheal ring was then fully reached by releasing the subcutaneous tissues using the index figure, and PDT was then performed. The two groups were compared in terms of their tracheostomy complications (including bleeding, pneumothorax, stoma infection and accidental decannulation) and duration of the procedure.
The two groups were homogeneous in terms of age, gender, mean APACHE score (P>0.05). There were no significant differences between the two groups in terms of the mean time from tracheal intubation to tracheostomy (P=0.869). The duration of the procedure was 5.16±1.72 minutes in the SSPDT group and 6.42±1.71 in the CPDT group (P<0.001). The complication rate was 7(8.75%) in the SSPDT group and 16(20%) in the CPDT group (P=0.043).
SSPDT is safer and has fewer complications than CPDT in ICU patients.
经皮扩张气管切开术（PDT）是重症监护病房（ICU）中常见的外科手术。本研究旨在比较半外科经皮扩张气管切开术（SSPDT）与传统经皮扩张气管切开术（CPDT）。
本随机临床试验针对160例入住医学重症监护病房（ICU）且有气管切开指征的患者进行，将其系统地分为两组，每组80例。在CPDT组中，做一个小切口后，将一根16号穿刺针盲目插入气管，并将导丝置于气管腔内。通过导丝置入单个扩张器形成造口。在SSPDT组中，在环状软骨下方1 cm处做一个横向切口（2 cm），然后用食指分离皮下组织充分暴露气管环，随后进行PDT。比较两组的气管切开并发症（包括出血、气胸、造口感染和意外脱管）及手术时间。
两组在年龄、性别、平均急性生理与慢性健康状况评分系统（APACHE）评分方面具有同质性（P>0.05）。两组从气管插管到气管切开的平均时间无显著差异（P=0.869）。SSPDT组手术时间为5.16±1.72分钟，CPDT组为6.42±1.71分钟（P<0.001）。SSPDT组并发症发生率为7例（8.75%），CPDT组为16例（20%）（P=0.043）。
在ICU患者中，SSPDT比CPDT更安全，并发症更少。
