经皮气管切开术在ICU的临床应用

目的:观察经皮扩张气管切开术在危重患者的临床疗效.方法:20例患者采用经皮扩张气管切开术,另26例采用传统气管切开术,比较经皮气管切开术和传统气管切开术的手术时间、术中出血量、相关并发症.结果:PDT组的操作时间、切口大小、术中出血量、相关并发症等比较,两组差异有统计学意义(P<0.05).结论:经皮扩张气管切开术较传统气管切开术是一种更快捷有效、准确性更高、并发症更少的人工气道建立方法,在重症监护病房(Icu)中有较大的临床应用价值.     

经皮扩张气管切开术在心外科的临床应用价值

目的通过比较传统开放性气管切开术（open tracheostomy,OT）和经皮扩张气管切开术（percutaneous dilational tracheostomy,PDT）在心脏外科术后危重病人中的应用,评价PDT在心外科的临床应用价值。方法40例正中开胸心脏手术后危重患者,2002年1月～2003年7月为OT组,2003年8月～2008年2月为PDT组,各20例,观察手术时间、切口长度、愈合时间、术中出血、生命体征的波动及术后不良反应等情况。结果PDT组手术时间（8.8±2.2）min、切口长度（1.3±0.2）cm、切口愈合时间（3.9±0.9）d,与OT组的（21.5±5.3）min、（3.4±0.5）cm、（5.9±1.2）d相比,均有显著性差异（t=-9.897,-17.440,-5.963,P=0.000）;术中Ⅱ度出血PDT组明显少于OT组[1例（5%）vs 13例（65%）,χ^2=15.824,P=0.000];术中平均动脉压、心率、脉搏血氧饱和度的波动PDT组明显小于OT组[1～5（中位数2）mm Hg vs 1～20（中位数3.5）mm Hg,Z=-2.959,P=0.003;3～12（中位数5.5）次/min vs 7～70（中位数10）次/min,Z=-3.956,P=0.000;0～4%（中位数2%）vs 0～31%（中位数3.5%）,Z=-3.548,P=0.000];不良反应切口溢痰的发生率PDT组明显低于OT组[1例（5%）vs 8例（40%）,χ2=5.161,P=0.023];总并发症发生率PDT组明显低于OT组[1例（5%）vs 12例（60%）,χ2=13.789,P=0.000）。结论PDT具有快速、创伤小、手术操作精确、易掌握、成功率高、并发症少等优势,是心血管术后危重病人气管切开的较好选择。     

经皮扩张气管切开术在救治重症颅脑疾病中的应用

目的 比较传统开放性气管切开术(OT)与经皮扩张气管切开术(PDT)在救治重症颅脑疾病中的应用。方法 回顾性分析OT组与PDT组并发症发生率、操作相关病死率和操作时间。结果 PDT组无1例发生操作相关死亡，仅1例发生并发症；OT组不同程度发生并发症，其中1例发生拔管后猝死；PDT组操作时间较OT组明显缩短。结论 经皮扩张气管切开术在重症颅脑疾病患者中应用具有操作时间短，并发症及操作相关死亡率低的优点，利于重症颅脑疾病的治疗。     

经皮扩张气管造口术在ICU昏迷患者中的应用

目的:分析经皮扩张气管造口术(PDT)在ICU昏迷患者中的应用.方法:选择60例行气管切开的ICU昏迷患者的临床资料,随机将60例病人分为经皮扩张气管造口术试验组(PDT组)和传统气管切开组(ST组),比较两组患者切口出血及皮下气肿的发生率、脱离呼吸机时间、ICU滞留时间、术后气管狭窄程度之间的差异.结果:ST术后切口出血及皮下气肿的发生率明显高于PDT术(P＜0.05);PDT组患者平均脱机时间明显短于ST组;PDT组患者术后气管狭窄明显低于ST组.结论:对ICU昏迷患者,PDT术的切口出血、皮下气肿、气管狭窄等并发症较ST术少,可减少患者住院时间,值得在临床推广应用.     

不同气管切开术在重型颅脑外伤患者临床转归中的效果比较

目的 探讨经皮扩张气管切开术（PDT）与传统气管切开术（TT）在重型颅脑外伤患者临床转归中的效果比较。方法 回顾分析神经监护中心2017年7月至2022年7月收治的243例重型颅脑外伤患者,经皮扩张气管切开组123例,传统气管切开组120例,从术后各种并发症发生率评估临床疗效。结果 两组患者术后主要并发症均无统计学意义（P>0.05）。轻微并发症中合计早期并发症（术后0～7天）差异有统计学意义（P<0.05）,且其中微出血存在统计学意义（P<0.05）。术后0～30天并发症中微出血也存在统计学意义（P<0.05）。两组术后气道I级狭窄及声门下轻、中度狭窄均存存在统计学意义（P<0.05）。结论 不同气管切开术在重型颅脑外伤患者临床转归中均有积极作用,经皮扩张气管切开术值得首选,同时对于个体化患者兼顾传统气管切开术。     

纤维支气管镜直视下经皮微创气管切开术在重症监护室中的应用

目的评价纤维支气管镜直视下经皮微创气管切开术在重症监护室中的应用价值。方法选择70例需气管切开且无禁忌证的患者,随机分为纤维支气管镜直视下经皮微创气管切开术组(A组,30例)和传统开放式气管切开术组(B组,40例)。比较两组间手术时间,切口大小,出血量,安全性,血液、痰液窒息等并发症等方面的差异。结果 A组手术时间较B组明显缩短,切口小,出血量明显减少,安全性明显提高,其他并发症明显减少,差异均有统计学意义(P0.05)。结论纤维支气管镜直视下经皮微创气管切开术具有操作简便,创伤小,安全性高,成功率高,并发症少等优势,在重症监护室中具有较大的应用价值。     

经皮扩张气管切开术在口腔颌面外科麻醉中的应用

目的探讨术前经皮扩张气管切开术(percutaneous dilatational tracheotomy,PDT)在口腔颌面外科手术麻醉中的临床应用价值,并与同期传统外科气管切开术(surgical tracheotomy,ST)进行比较。方法收集2013年5月至2015年5月,在我院口腔颌面外科行肿瘤根治伴皮瓣转移修复并且做气管切开术的124例患者资料,包括患者的一般资料、麻醉用药、气管切开时的生命体征、手术时间、出血量、并发症发生情况等。结果 124例患者中41例行PDT(P组),83例行ST(S组),两组患者一般资料差异无统计学意义。P组切口长度和手术时间均明显短于S组(P0.05),术中出血量明显少于S组(P0.05)。两组并发症发生率差异无统计学意义。结论与ST相比,PDT具有更多优点,更加适合于口腔颌面外科手术的气道管理。     

经皮穿刺气管切开术的临床应用

气管切开术是抢救急危重症患者必不可少的手段.传统气管切开术(open tracheostpmy,OT)需要较高的专科技术,操作步骤复杂,创伤大,并发症较多,设备器械要求高,且受场地、体位限制和手术时间长等因素的制约,不利于急救和临床广泛应用.我院麻醉科自2007年开展了经皮穿刺气管切开术(PDT),与OT比较,该方法快速、安全、简便、并发症少,现报道如下.     

非纤维支气管镜辅助经皮旋转扩张气管切开术的临床应用

目的评价在非纤维支气管镜辅助下开展经皮旋转扩张气管切开术的临床应用价值。方法2008年1月至2009年2月ICU病区符合气管切开手术指征危重患者30例，采用经皮旋转扩张气管切开术，手术均在非纤维支气管镜辅助下完成；观察手术时间、术中出血情况及其他相关并发症。结果本组平均手术时间（6．0±0．5）min，术中出血量极少，均为Ⅰ度出血，无其他严重并发症发生。结论非纤维支气管镜辅助下行经皮旋转扩张气管切开术，具有手术时间短、并发症少等优点，只要谨慎操作，是安全有效的，值得临床推广。     

经皮扩张气管套管导入术在ICU危重患者中的应用

重症监护病房(ICU)的危重患者常合并呼吸功能障碍, 如处理不当则可成为致死原因。气管切开术是抢救危重患者常用的外科操作之一,手术方法包括传统的气管切开术和经皮扩张气管套管导入术(PDT)等,PDT在国外已广泛应用于危重患者的抢救。本研究拟观察危重患者PDT的应用, 并与传统的气管切开术进行比较。     

改良经皮扩张气管切开术与常规经皮扩张气管切开术效果对比

目的分析改良经皮扩张气管切开术与常规经皮扩张气管切开术的临床应用效果。方法选取2014-01—2015-12间在急诊科室以及ICU内需要接受气管切开的患者102例,按照手术方法分为2组。改良经皮扩张气管切开术患者设为观察组,常规经皮扩张气管切开术设为对照组。对比2组患者手术情况、手术费用、术中出血及术后并发症等。结果 2组患者的切口长度、手术时间、术中出血量、术后渗血量、切口愈合时间及并发症发生率差异均无统计学意义(P0.05)。但观察组的手术费用明显少于对照组,差异有统计学意义(P0.05)。结论改良经皮扩张气管切开术在术后并发症、创伤性、操作性上具有与常规经皮扩张气管切开术相同的优势,但是更加安全、经济。     

Percutaneous dilatational tracheostomy is as safe as open tracheostomy

Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. OT was performed in the operating room whereas PDT was performed in intensive care units (ICUs). PDT was performed by surgeons and medical intensivists under a strict institutional policy and procedure governing patient selection and conduct of the procedure. Complications were defined as bleeding, loss of airway, hypotension, hypoxia, tracheostomy tube malposition, subcutaneous emphysema, infection, and conversion of PDT to OT. All patients survived the operation. PDT and OT had similar complication rates: 2.1 per cent for PDT versus 2.8 per cent for OT (P = not significant). Postoperative bleeding, which was the most frequent complication, occurred in one PDT patient and four OT patients. One PDT patient required conversion to OT as a result of extensive tracheal fibrosis. Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.     

实时超声引导下经皮扩张气管切开术在心脏外科术后的临床应用

目的探讨经皮扩张气管切开术（PDT）中应用超声探查及引导穿刺在心脏外科术后患者中的应用效果。方法2008年7月至2012年8月南京大学医学院附属鼓楼医院心脏术后行气管切开患者共51例,其中瓣膜置换术后20例,主动脉夹层（De BakeyI型）术后17例,冠状动脉旁路移植术11例,先天性心脏病矫治术后3例。根据切开方式不同将患者分为手术切开（sT）组17例,男10例、女7例,年龄（58．0±15．2）岁;纤维支气管镜辅助经皮扩张气管切开（FOB-PDT）组21例,男15例、女6例,年龄（63．5±13．5）岁;超声辅助经皮扩张气管切开（US-PDT）组13例,男7例、女6例,年龄（64．5±10．2）岁。比较3组手术结果及并发症发生情况。结果所有PDT均顺利完成,ST组中手术失败1例。总体出血事件ST组为41．18％、FOB-PDT组9．53％、US-PDT组7．70％（P=0．038）,纵隔感染发生率sT组17．65％、FOB-PDT组及US-PDT组均为0％（P=0．046）,差异有统计意义。3组气管内导管保留时间、住ICU时间、住院时间、死亡率及术中低氧血症、气胸、皮下气肿等发生率差异无统计学意义,ST组1例后期发生气管狭窄。结论PDT结合实时超声检查能够提供颈部解剖信息,指导穿刺部位选择,在心脏术后患者中应用能够提高手术安全性,降低操作难度,降低相关并发症发生率。     

PercuTwist: a new alternative to Griggs and Ciaglia's techniques

BACKGROUND AND OBJECTIVE: Tracheostomy is one of the most common procedures in intensive care units worldwide. In this study we aimed to compare three different tracheostomy techniques with respect to duration of procedure and complications. METHODS: One hundred and thirty patients requiring endotracheal intubation for more than 10 days due to acute respiratory distress syndrome, infections or cerebrovascular events were consecutively selected to undergo the percutaneous dilatational tracheostomy technique (PDT n = 44), the guide-wire dilating forceps technique group (GWDF n = 41) or the PercuTwist technique (n = 45). The time taken to perform the procedure (skin incision to successful placement of tracheostomy tube) and complications were recorded. RESULTS: The operating times were found to be 9.9 +/- 1.1, 6.2 +/-1.4 and 5.4 +/- 1.2 min in PDT, GWDF and PercuTwist groups, respectively. The duration of the procedure was significantly shorter in the PercuTwist group as compared to the percutaneous dilatational tracheostomy (P < 0.01) and guide-wire dilating forceps (P < 0.05) groups. During postoperative bronchoscopy, eight cases of longitudinal tracheal abrasion (four in the PDT group, two in the GWDF group and two in the PercuTwist group), two cases of posterior tracheal wall injury (one in PDT and one in GWDF) and one case of tracheal ring rupture in the PDT group were seen. CONCLUSIONS: Percutaneous tracheostomy techniques have their own advantages and complications. PercuTwist, a new controlled rotating dilatation method, was associated with minimal complications, appears to be easy to perform and a practical alternative to percutaneous dilatational tracheostomy and guide-wire dilating forceps techniques.     

Percutaneous dilatational tracheostomy: still a surgical procedure.

Although percutaneous dilatational tracheostomy (PDT) has been shown to be a cost-effective bedside alternative to open tracheostomy (OT), prior reports of the complications of the procedure are contradictory. Reported complications range from minor events to fatal ones, in varying percentages. This prospective study was designed to identify the type and severity of complications accompanying the introduction of PDT to a tertiary medical center. Surgical and medical intensive care unit (ICU) patients requiring elective tracheostomy were identified as appropriate for PDT using approved institutional criteria. All procedures were performed at an ICU bedside in the presence of a surgeon privileged to perform OT. Demographic data, procedural information, and patient outcome (including minor and major complications, length of stay, and survival) were collected. PDT was performed in 96 ICU patients, with complete data available for 95 patients. PDT was performed in an average of 13.1+/-1.0 minutes. Twenty-three major and minor complications occurred, including two perioperative deaths, in 15 patients (15.8%). A total of 37 PDT patients (38.9%) died in the hospital, indicative of the severity of illness of patients requiring tracheostomy. Based on the experience to date, Cedars-Sinai Medical Center (Los Angeles, CA) continues to require a surgeon privileged to perform OT to participate in all PDT procedures.     

Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy

Background : As no clinical randomised studies have previously been performed comparing complications with the Ciaglia Percutaneous Dilatational Tracheostomy Introducer Set (PDT) and conventional surgical tracheostomy (TR), we designed a study with the aim of comparing the efficacy and safety of the two techniques.
Methods : Sixty patients selected for elective tracheostomy were randomised for either PDT (30 patients) or TR (30 patients). All patients had general anaesthesia and were ventilated with 100% oxygen. Furthermore, lidocaine with epinephrine 1% (3–5 ml) was used for local analgesia and to minimise bleeding during the procedure.
Results : The median time for insertion of the tracheostomy tube was 11.5 min (range 7–24 min) in the PDT group and 15 min (range 5–47 min) in the TR group ( P <0.01). Complications during the procedure were cuff puncture of the endotracheal tube in 5 cases in the PDT group. Minor bleeding was encountered in 6 cases in the PDT group as opposed to 24 cases in the TR group ( P <0.01), major bleeding in none versus 2 cases, respectively. In 8 cases in the PDT group, increased resistance to insertion of the tracheostomy tube was met by further dilatation. During the post-tracheostomy period, complications occurred with minor bleeding in 2 cases in the PDT group as opposed to 9 cases in the TR group ( P <0.05), and major bleeding was encountered in 1 case in each group. Minor infections were encountered in 3 cases in the PDT group as opposed to 11 cases in the TR group ( P <0.01). Major infection was encountered in none versus 8 cases, respectively ( P <0.01).
Conclusion : Our results indicate that the percutaneous dilatational tracheostomy technique performed with the Ciaglia Introducer Set is effective, safe and superior to conventional surgical tracheostomy as immediate complications as well as complications with the tracheostomy tube in situ are fewer and of less severity.     

微创气管切开术在危重病人的应用

目的 探讨经皮穿刺扩张气管切开术在危重病患的应用。方法回顾本院1996-2000年间实施的28例危重病患经皮穿刺扩张气管切开术的手术时间、围手术期手术并发症及随访结果。结果 28例均顺利完成手术，手术期间无严重并发症发生，术中出血极少。随访最长18个月，美容效果好。结论 经皮穿刺扩张气管切开术是一种非常好的微创手术，只要经过严格训练并掌握适应证，可以满足绝大部分的临床需要，对危重病患尤为需要。     

单中心10年经皮扩张气管切开术的临床分析

目的评价ICU危重病患者床边开展经皮扩张气管切开术（percutaneous dilational tracheostomy,PDT）的安全性。方法 2001年5月-2010年12月,对421例需长时间机械通气的危重病患者在床边行PDT,男309例（73.4%）,女112例（26.6%）,年龄（57.6±19.7）岁,PDT前插管时间（10.2±5.7）d。采用经导丝导引下经皮扩张钳气管切开（guide wire dilatingforceps,GWDF）技术。记录患者一般资料、PDT前插管时间、PDT手术时间、PDT后机械通气（MV）时间、总MV时间和气管套管留置时间,同时记录术中并发症、术后3 d内和3 d后并发症。回顾性记录住ICU时间和住院时间以及患者预后。结果 PDT手术时间（10.3±3.8）min,PDT后MV时间1-249 d（中位数17.0 d）,总MV时间6-260 d（中位数26.0 d）,气管套管留置时间21-186 d（中位数43.5 d）。术中并发症发生率8.3%（35例）,3 d内并发症发生率5.9%（25例）,3 d后并发症发生率4.0%（17例）。住ICU时间6-331 d（中位数32.4 d）,ICU死亡率16.4%（69例）。住院时间6-653 d（中位数58.5d）,死亡率18.5%（78例）。结论 PDT技术是创伤小、操作简单、并发症少和安全性高的微创外科方法,是危重病患者预期长时间MV的较好选择。