深静脉穿刺包联合扩张钳改良经皮扩张气管切开术式的临床应用观察(1)
摘要：目的 评价深静脉穿刺包联合扩张钳改良经皮扩张气管切开术式的临床应用价值。方法 回顾性分析宣城市人民医院重症医学科36例行气管切开患者的临床资料，其中试验组18例，对照组18例。比较两组间切口大小、手术时间等手术情况以及各种相关并发症的发生率。结果 ①两组患者切口大小、手术时间、术中出血比较，差异均无统计学意义(P>0.05)；而试验组患者的手术费用明显低于对照组，差异有统计学意义(P<0.05)。②两组患者术后渗血量、低氧血症、支气管痉挛、皮下气肿、心律失常发生率比较，差异均无统计学意义(P>0.05)。③两组患者切口感染、气管软化、气管狭窄发生率比较，差异均无统计学意义(P>0.05)。结论 深静脉穿刺包联合扩张钳改良经皮扩张气管切开术式值得推广。
关键词：深静脉穿刺包；扩张钳；改良经皮扩张气管切开术
Clinical Application Observation of the Modified Pereutaneous Dilative Tracheostomy with Deep Venous Catheter Package Joint Spreading Forceps
, http://www.100md.com
WEI Ji-hong， TANG Yu-zhen， ZHANG Guo-hu， WU Zong-hui， MEI Hai-xia， XU Yuan-ping， DING Hui-qiang
(Department of Intensive Care Medicine， The People's Hospital of Xuancheng City， Xuancheng 242000，Anhui，China)
Abstract：Objective To evaluate the clinical application value of the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps. Methods The clinical data of 36 patients experienced tracheostomy in intensive care unit(ICU)of the People's Hospital of Xuancheng City were retrospectively analyzed. There were 18 cases in test group and 18 cases in control group. The operation information such as incision size， operation time， blood loss and the incidence of various related complications were observed among two groups. Results ①The incision size， operation time， and blood loss showed no statistically significant difference between the two groups(P>0.05)， but the cost of test group was significantly lower than the control group(P<0.01). ②The post-operational blood loss and the incidence of hyoxemia， bronchospasm， pneumoderm， arrhythmia showed no statistically significant difference between the two groups(P>0.05). ③The incidence of incision infection， tracheomalacia， tracheostenosis showed no statistically significant difference between the two groups(P>0.05). Conclusion It is worth to generalize the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps.
, http://www.100md.com
Key words：Deep venous catheter package；Spreading forceps； Modified pereutaneous dilative tracheostomy
气管切开是危重患者建立人工气道的常用方法，但常规气管切开手术存在组织损伤大、手术耗时长、术中患者耐受性差、术中长时间缺氧及并发症多(如大出血、气胸、气道狭窄、心跳呼吸骤停等)等缺点，为此，Shelden[1]等提出经皮扩张气管切开术(percutaneous dilational tracheostomy，PDT)，自1985年Ciaglia等[2]改进了经皮扩张气管切开术后的20余年来，因其操作简单、迅速、并发症少，而在重症医学科逐渐开展。我院在2012年采用Smiths公司生产的Portex一次性微创气管切开器械也开展了该项技术，使用中发现采用其原装耗材昂贵不利于类似我院的三线及以下城市的临床推广。为次我科于2013年对原操作方案予以改良，采用深静脉包联合扩张钳操作，获得了更好的价效及时效比，现报道如下。
1 资料与方法, http://www.100md.com(魏继红 唐玉珍 张国虎 吴宗辉 梅海霞 徐元平)
关键词：深静脉穿刺包；扩张钳；改良经皮扩张气管切开术
Clinical Application Observation of the Modified Pereutaneous Dilative Tracheostomy with Deep Venous Catheter Package Joint Spreading Forceps
, http://www.100md.com
WEI Ji-hong， TANG Yu-zhen， ZHANG Guo-hu， WU Zong-hui， MEI Hai-xia， XU Yuan-ping， DING Hui-qiang
(Department of Intensive Care Medicine， The People's Hospital of Xuancheng City， Xuancheng 242000，Anhui，China)
Abstract：Objective To evaluate the clinical application value of the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps. Methods The clinical data of 36 patients experienced tracheostomy in intensive care unit(ICU)of the People's Hospital of Xuancheng City were retrospectively analyzed. There were 18 cases in test group and 18 cases in control group. The operation information such as incision size， operation time， blood loss and the incidence of various related complications were observed among two groups. Results ①The incision size， operation time， and blood loss showed no statistically significant difference between the two groups(P>0.05)， but the cost of test group was significantly lower than the control group(P<0.01). ②The post-operational blood loss and the incidence of hyoxemia， bronchospasm， pneumoderm， arrhythmia showed no statistically significant difference between the two groups(P>0.05). ③The incidence of incision infection， tracheomalacia， tracheostenosis showed no statistically significant difference between the two groups(P>0.05). Conclusion It is worth to generalize the modified pereutaneous dilative tracheostomy with deep venous catheter package joint spreading forceps.
, http://www.100md.com
Key words：Deep venous catheter package；Spreading forceps； Modified pereutaneous dilative tracheostomy
气管切开是危重患者建立人工气道的常用方法，但常规气管切开手术存在组织损伤大、手术耗时长、术中患者耐受性差、术中长时间缺氧及并发症多(如大出血、气胸、气道狭窄、心跳呼吸骤停等)等缺点，为此，Shelden[1]等提出经皮扩张气管切开术(percutaneous dilational tracheostomy，PDT)，自1985年Ciaglia等[2]改进了经皮扩张气管切开术后的20余年来，因其操作简单、迅速、并发症少，而在重症医学科逐渐开展。我院在2012年采用Smiths公司生产的Portex一次性微创气管切开器械也开展了该项技术，使用中发现采用其原装耗材昂贵不利于类似我院的三线及以下城市的临床推广。为次我科于2013年对原操作方案予以改良，采用深静脉包联合扩张钳操作，获得了更好的价效及时效比，现报道如下。
1 资料与方法, http://www.100md.com(魏继红 唐玉珍 张国虎 吴宗辉 梅海霞 徐元平)