CAJ | 학술논문

目的：探讨经皮气管切开术（ PDT）与传统气管切开术在老年脑卒中患者救治中的疗效及安全性。方法选择2011年6月-2013年6月在河北联合大学附属医院神经外科重症监护室住院的老年脑卒中患者143例，并按事先编好的号码将患者在微机中随机分入传统气管切开术（传统）组和PDT组。比较两种手术方法的操作时间、切口大小、术中出血量、切口愈合时间，术中大量出血（>100 ml）、术后皮下气肿、气胸、气管套管脱出、食管损伤、食管瘘、迟发性大出血（>100 ml）、气管软化塌陷、切口感染等并发症的发生率。结果术前传统组68例，PDT组75例，术后传统组排除和脱失43例，PDT组排除和脱失43例。两组患者的性别构成、年龄、发病到气管切开时间、术前格拉斯哥昏迷评分（ GCS）、脑卒中类型分布情况比较，差异均无统计学意义（ P>0.05）。两组患者均手术成功， PDT组手术操作时间、切口愈合时间均短于传统组，切口小于传统组，术中出血量少于传统组，差异有统计学意义（P<0.05）。传统组术中及术后并发症发生率为20.0%（5/25），PDT 组为9.3%（3/32），差异无统计学意义（χ2越1.313，P>0.05）。结论 PDT相较于传统气管切开术能有效快速地建立老年脑卒中患者的气道，降低术中及术后并发症发生率，值得临床推广应用。
목적：탐토경피기관절개술（ PDT）여전통기관절개술재노년뇌졸중환자구치중적료효급안전성。방법선택2011년6월-2013년6월재하북연합대학부속의원신경외과중증감호실주원적노년뇌졸중환자143례，병안사선편호적호마장환자재미궤중수궤분입전통기관절개술（전통）조화PDT조。비교량충수술방법적조작시간、절구대소、술중출혈량、절구유합시간，술중대량출혈（>100 ml）、술후피하기종、기흉、기관투관탈출、식관손상、식관루、지발성대출혈（>100 ml）、기관연화탑함、절구감염등병발증적발생솔。결과술전전통조68례，PDT조75례，술후전통조배제화탈실43례，PDT조배제화탈실43례。량조환자적성별구성、년령、발병도기관절개시간、술전격랍사가혼미평분（ GCS）、뇌졸중류형분포정황비교，차이균무통계학의의（ P>0.05）。량조환자균수술성공， PDT조수술조작시간、절구유합시간균단우전통조，절구소우전통조，술중출혈량소우전통조，차이유통계학의의（P<0.05）。전통조술중급술후병발증발생솔위20.0%（5/25），PDT 조위9.3%（3/32），차이무통계학의의（χ2월1.313，P>0.05）。결론 PDT상교우전통기관절개술능유효쾌속지건립노년뇌졸중환자적기도，강저술중급술후병발증발생솔，치득림상추엄응용。
Objective TostudythecurativeeffectsandsafetyofoercutaneousDilationalTracheostomy(PDT)and traditionaltracheotomyintreatmentofelderlystrokeoatients.Methods Atotalof143elderlystrokeoatientshosoitalizedinAf-filiated Hosoital of Hebei United University from June 2011 to June 2013 were divided randomly into grouos traditional tracheotomy (TT grouo,n=68),PDT(n=75). The ooerating time,incision sizes,wound healing time,incidences of intraooerative mas-sive bleeding( >100 ml),oost-ooerative subcutaneous emohysema,oneumothorax,tracheal tube orolaose,esoohageal injury, esoohageal fistula,delayed bleeding( >100 ml),tracheomalacia,incision infection and other comolications were comoared. Results Afterooeration,43oatientswereexcludedandlostinTTgrouo,43inPDTgrouo.Therewasnosignificantdifference in gender,age,time from onset to tracheotomy,ore -ooerative GCS scores,distribution of stroke tyoes ( P >0. 05 ). Both grouos had successful ooerations,the time of ooeration and healing was shorter,the sizes of incisions smaller,intraooerative bleeding amount less in PDT grouo than in TT grouo,the difference was significant(P<0. 05). The incidence of intraooerative, oostooerative comolications was 20. 0%(5/25)in TT grouo,9. 4%(3/32)in PDT grouo,the difference was no significant (χ2=1.313,P>0.05).Conclusion Comoaredwithtraditionaltracheotomy,PDTcancreateairwayeffectivelyandraoidly and reduce the incidence of intraooerative and oostooerative comolications in elderly stroke oatients,which is worthy of clinical oooularization and aoolication.