Caruso D M, al-Kasspooles M F, Matthews M R, Weiland D E, Schiller W R
Department of Surgery, Maricopa Medical Center, Phoenix, AZ 85008, USA.
J Burn Care Rehabil. 1997 Sep-Oct;18(5):424-8. doi: 10.1097/00004630-199709000-00010.
Several investigators have cited the numerous complications that occur with conventional tracheostomies in patients with burn injuries. However, none of these studies included the technique of percutaneous dilatational tracheostomy, which has been shown to significantly decrease operative time, cost, perioperative, and long-term sequelae as compared to conventional tracheostomy. A retrospective analysis of 36 patients with burn injuries, from 1400 burn admissions, was conducted to compare conventional tracheostomy versus percutaneous dilatational tracheostomy. In this study, percutaneous dilatational tracheostomy resulted in significantly decreased operative times and cost compared to conventional tracheostomy. There were no major operative complications in either group, and alveolar-arterial oxygen gradients were improved in 71% of the patients with a tracheostomy. Percutaneous dilatational tracheostomy is an efficacious technique for airway management in patients with burn injuries. It can be safely performed at the bedside, at one fourth the cost of a conventional tracheostomy. Percutaneous dilatational tracheostomy may also benefit the patient with severe burns by decreasing alveolar-arterial oxygen gradients. Improved ventilatory mechanics might allow for a shorter duration of mechanical ventilation, thereby decreasing patient morbidity, hospital stay, and cost.
几位研究者列举了烧伤患者进行传统气管切开术时出现的诸多并发症。然而，这些研究均未涉及经皮扩张气管切开术，与传统气管切开术相比，经皮扩张气管切开术已被证明可显著缩短手术时间、降低成本、减少围手术期及长期后遗症。对1400例烧伤入院患者中的36例进行了回顾性分析，以比较传统气管切开术与经皮扩张气管切开术。在本研究中，与传统气管切开术相比，经皮扩张气管切开术显著缩短了手术时间并降低了成本。两组均未出现重大手术并发症，71%行气管切开术的患者肺泡 - 动脉氧梯度得到改善。经皮扩张气管切开术是烧伤患者气道管理的一种有效技术。它可在床边安全实施，成本仅为传统气管切开术的四分之一。经皮扩张气管切开术还可能通过降低肺泡 - 动脉氧梯度使重度烧伤患者受益。改善的通气力学可能使机械通气时间缩短，从而降低患者发病率、住院时间和成本。
