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目的评价经皮扩张气管切开术(PDT)在重症监护病房(ICU)危重症患者人工气道建立中的应用价值。方法将46例收住ICU的危重症患者随机分为两组。PDT组23例实施PDT建立人工气道,对照组23例实施传统开放式气管切开术(OT)。比较两组镇静剂用量、手术操作时间、切口大小、出血量、切口愈合时间、疤痕大小、手术过程中患者生命体征变化、手术相关并发症发生率。结果 PDT组和对照组丙泊酚用量分别为(45.88±14.53)mg和(117.18±22.55)mg,手术时间分别为(9.66±3.25)min和(17.63±3.86)min,术中出血量分别为(5.17±2.41)ml和(14.18±3.61)ml,切口大小分别为(1.52±0.38)cm和(3.72±0.27)cm,切口愈合时间分别为(3.87±0.32)d和(6.63±1.15)d,手术疤痕大小分别为(0.26±0.04)cm2和(1.39±0.26)cm2,两组比较差异有统计学意义(P<0.01或0.05);手术前监测PDT组和对照组患者平均动脉压(MAP)分别为(77.44±3.17)mmHg(1mmHg=0.133kPa)和(76.15±3.86)mmHg,心率(HR)分别为(81.67±5.37)次/min和(80.69±4.82)次/min,SpO2分别为(97.92±1.76)%和(97.83±1.86)%,两组比较差异均无统计学意义;术中监测MAP分别为(82.81±4.20)mmHg和(88.63±8.96)mmHg,HR分别为(85.35±7.77)次/min和(92.17±12.23)次/min,SpO2分别为(95.22±2.73)%和(91.38±3.67)%,两组比较差异有统计学意义(P<0.05);PDT组和对照组患者手术前后MAP变化值分别为(5.37±1.18)mmHg和(12.48±4.52)mmHg,HR变化值分别为(3.68±2.03)次/min和(11.48±6.02)次/min,SpO2变化值分别为(2.70±0.89)%和(6.45±1.63)%,两组比较差异有统计学意义(P<0.05)。PDT组术后并发症发生率明显小于对照组(χ2=8.1778,P<0.01)。结论 PDT是一种安全、有效、快捷的微创急救技术,值得在ICU推广应用。
Objective To evaluate the value of percutaneous dilational tracheostomy (PDT) in establishing artificial airway in critically ill patients in intensive care unit (ICU). Methods Forty-six critically ill patients in ICU were randomly divided into two groups. Twenty-three patients in the PDT group underwent PDT to establish an artificial airway, while 23 patients in the control group received conventional open tracheotomy (OT). The amounts of sedatives, operation time, incision size, bleeding volume, incision healing time, scar size, changes of vital signs in patients during surgery, and the incidence of complications related to surgery were compared between the two groups. Results The dosage of propofol in PDT group and control group were (45.88 ± 14.53) mg and (117.18 ± 22.55) mg respectively, and the operation time was (9.66 ± 3.25) min and (17.63 ± 3.86) min respectively. The intraoperative blood loss were (5.17 ± 2.41) ml and (14.18 ± 3.61) ml respectively. The incision size was (1.52 ± 0.38) cm and (3.72 ± 0.27) cm respectively. The incision healing time was (3.87 ± 0.32) d and (0.26 ± 0.04) cm2 and (1.39 ± 0.26) cm2, respectively, with significant differences between the two groups (P <0.01 or 0.05). The mean arterial pressure (MAP) in the PDT group and the control group ) Were (77.44 ± 3.17) mmHg (1mmHg = 0.133kPa) and (76.15 ± 3.86) mmHg respectively. The heart rate was (81.67 ± 5.37) / min and (80.69 ± 4.82) / min respectively. SpO2 was (97.92 ± 1.76)% and (97.83 ± 1.86)%, respectively. There was no significant difference between the two groups. The intraoperative MAP was (82.81 ± 4.20) mmHg and (88.63 ± 8.96) mmHg respectively, and HR was (85.35 ± 7.77) times / min and (92.17 ± 12.23) times / min, SpO2 were (95.22 ± 2.73)% and (91.38 ± 3.67)% respectively, there was significant difference between the two groups (P <0.05) The changes of MAP in group before and after operation were (5.37 ± 1.18) mmHg and (12.48 ± 4.52) mmHg, HR change (3.68 ± 2.03) / min and (11.48 ± 6.02) / min respectively, and the changes of SpO2 were (2.70 ± 0.89)% and (6.45 ± 1.63)% respectively, with significant difference between the two groups <0.05). The incidence of postoperative complications in PDT group was significantly lower than that in control group (χ2 = 8.1778, P <0.01). Conclusion PDT is a safe, effective and quick minimally invasive emergency treatment technology, which is worth popularizing and applying in ICU.