CAJ | 학술논문

目的：探讨电子支气管镜分步操作协助经皮扩张气管切开术（ PDT）在重症医学科（ICU）的临床应用价值。方法回顾性分析重症医学科136例行气管切开重症患者的临床资料，共分 A、B、C 组，A 组为传统外科气管切开术（ST）39例，B 组为单纯经皮扩张气管切开术（PDT）65例，C 组为电子支气管镜协助 PDT32例。比较3组手术操作时间、术中出血量、手术并发症发生率以及切口愈合时间。结果 C 组与 B 组手术时间（min：8.5±2.4、6.8±2.5）、术中出血量（ml：4.6±2.3、5.7±2.1）、切口长度（cm：1.5±0.5、1.4±0.9）以及切口愈合时间（d：3.5±1.7、3.2±1.8）均明显优于 A 组（分别为20±5.6 min、15.9±2.4 ml、3.5±1.6 cm、6.7±2.1 d）差异显著（均 P ﹤0.01）。B 组与 C 组间切口长度、术中出血量、切口愈合时间比较无统计学差异，手术时间 C 组短于 B 组，差异有统计学意义（ P ﹤0.05）。两组手术并发症发生率均低于 A 组，差异有统计学意义（ P ﹤0.05）。C 组后壁损伤的发生率低于 B 组，差异有统计学意义（ P ﹤0.05）。结论电子支气管镜协助 PDT 是一种快速、微创、并发症少、预后良好的操作技术，值得在临床推广应用。
목적：탐토전자지기관경분보조작협조경피확장기관절개술（ PDT）재중증의학과（ICU）적림상응용개치。방법회고성분석중증의학과136례행기관절개중증환자적림상자료，공분 A、B、C 조，A 조위전통외과기관절개술（ST）39례，B 조위단순경피확장기관절개술（PDT）65례，C 조위전자지기관경협조 PDT32례。비교3조수술조작시간、술중출혈량、수술병발증발생솔이급절구유합시간。결과 C 조여 B 조수술시간（min：8.5±2.4、6.8±2.5）、술중출혈량（ml：4.6±2.3、5.7±2.1）、절구장도（cm：1.5±0.5、1.4±0.9）이급절구유합시간（d：3.5±1.7、3.2±1.8）균명현우우 A 조（분별위20±5.6 min、15.9±2.4 ml、3.5±1.6 cm、6.7±2.1 d）차이현저（균 P ﹤0.01）。B 조여 C 조간절구장도、술중출혈량、절구유합시간비교무통계학차이，수술시간 C 조단우 B 조，차이유통계학의의（ P ﹤0.05）。량조수술병발증발생솔균저우 A 조，차이유통계학의의（ P ﹤0.05）。C 조후벽손상적발생솔저우 B 조，차이유통계학의의（ P ﹤0.05）。결론전자지기관경협조 PDT 시일충쾌속、미창、병발증소、예후량호적조작기술，치득재림상추엄응용。
Objective To investigate the percutaneous tracheotomy with assistant of electronic bronchoscope in the intensive care unit. Methods The clinical data of 136 critical care patients experienced intensive care unit of Yuncheng people hospital from March 2009 to December 2014. Group A included 39 cases with conventional surgical tracheotomy,Group B included 65 cases with percutaneous dilative tracheotomy and Group C included 32 cases experienced percutaneous dilative tracheotomy with assistant of electronic bronchoscope. The operation information such as operation time,blood loss,length of incision,incision healing time and the incidence of complication were observed among the groups. Results The operation time(min:8. 5 ± 2. 4,6. 8 ± 2. 5),amount of blood loss(ml:4. 6 ± 2. 3,5. 7 ± 2. 1),length of incision(cm:1. 5 ± 0. 5, 1. 4 ± 0. 9)and healing time(d:3. 5 ± 1. 7,3. 2 ± 1. 8)in Group C and Group B were superior to Group A(20 ± 5. 6,15. 9 ± 2. 4,3. 5 ± 1. 6,6. 7 ± 2. 1,respectively),with statistical significances(all P ﹤ 0. 05),but there was no significant difference in above indexes except op-eration time between Group C and Group B. The incidence of complication in Group C and Group B were significantly lower than those in Group A . Between Group C and Group B,the occurrence rate of tracheal wall injury was lower in Group C( P ﹤ 0. 05). Conclusion Percutaneous tracheotomy operation with assistant of electronic bronchoscope is more effective,simple,with better prognosis and less complication,and is very suitable for patients in the intensive care unit.