CAJ | 학술논문

目的：探讨采用经皮扩张气管切开导管行胸腔闭式引流术在气胸抢救中的临床价值。方法采用前瞻性随机对照研究方法，选择2010年6月至2014年6月河北医科大学附属衡水市哈励逊国际和平医院重症医学科收治的气胸患者32例，按随机数字表法分为对照组和观察组，每组16例。在治疗原发病的同时，对照组采用传统硅胶管行胸腔闭式引流，由胸科医师完成；观察组应用经皮扩张气管切开导管行胸腔闭式引流，由重症医师独立完成。观察两组患者的治疗效果及并发症发生情况。结果与对照组比较，观察组从确诊气胸到手术完成时间明显缩短（min：8.00±1.36比23.06±3.83，t＝14.790，P＝0.000）；留管时间明显缩短（d：5.37±1.02比7.31±1.70，t＝7.286，P＝0.000）；住院期间引流管调整次数明显减少（次：0.18±0.40比3.87±1.14，t＝12.128，P＝0.000）；胸部X线检查次数明显减少（次：1.12±0.34比2.93±0.77，t＝8.589， P＝0.000）；住院时间明显缩短（d：8.30±1.37比24.56±5.62，t＝17.289，P＝0.000）；引流管脱出（0比3例）、引流管堵塞（0比5例）、皮下气肿（3比16例）等并发症发生例数明显减少，而切口感染（1比3例）、胸腔内感染（0比2例）发生情况无明显差异。结论应用经皮扩张气管切开导管行胸腔闭式引流治疗气胸安全、简便，能够由重症医师独立完成，且并发症较少，疗效肯定。
목적：탐토채용경피확장기관절개도관행흉강폐식인류술재기흉창구중적림상개치。방법채용전첨성수궤대조연구방법，선택2010년6월지2014년6월하북의과대학부속형수시합려손국제화평의원중증의학과수치적기흉환자32례，안수궤수자표법분위대조조화관찰조，매조16례。재치료원발병적동시，대조조채용전통규효관행흉강폐식인류，유흉과의사완성；관찰조응용경피확장기관절개도관행흉강폐식인류，유중증의사독립완성。관찰량조환자적치료효과급병발증발생정황。결과여대조조비교，관찰조종학진기흉도수술완성시간명현축단（min：8.00±1.36비23.06±3.83，t＝14.790，P＝0.000）；류관시간명현축단（d：5.37±1.02비7.31±1.70，t＝7.286，P＝0.000）；주원기간인류관조정차수명현감소（차：0.18±0.40비3.87±1.14，t＝12.128，P＝0.000）；흉부X선검사차수명현감소（차：1.12±0.34비2.93±0.77，t＝8.589， P＝0.000）；주원시간명현축단（d：8.30±1.37비24.56±5.62，t＝17.289，P＝0.000）；인류관탈출（0비3례）、인류관도새（0비5례）、피하기종（3비16례）등병발증발생례수명현감소，이절구감염（1비3례）、흉강내감염（0비2례）발생정황무명현차이。결론응용경피확장기관절개도관행흉강폐식인류치료기흉안전、간편，능구유중증의사독립완성，차병발증교소，료효긍정。
Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.