CAJ | 학술논문

目的对比研究两种经皮扩张气管切开术(percutaneous dilational tracheostomy,PDT)即经皮导丝扩张钳技术(guidewire dilating forceps,Portex法)和改良单步扩张技术(improved onestep dilation technique,the Ciaglia Blue Rhino method,CBR法)的操作时间、手术并发症及操作者适宜人群.方法选取2013年3月至2014年02月入住首都医科大学附属复兴医院ICU,拟行气管切开的患者,随机分为Portex组和CBR组,对两组的手术时间、出血量和手术并发症等进行比较.对参与该项研究的操作者进行调查,询问其对两种不同操作方式的看法.结果共有48例患者参与了该项研究,年龄(76.7±11.6)岁,其中男性为25例(52.1％),行气管切开的原因为:预计机械通气时间大于2周(30例)、重度意识障碍(17例)、上气道梗阻(1例);参与该项研究的患者随机分为Portex组和CBR组,两组患者在年龄、性别、入ICU的APACHEⅡ评分、气管切开的原因、气管切开前的机械通气时间、术前的凝血功能等方面均差异无统计学意义;操作时间与手术并发症的比较结果:操作时间CBR法显著低于Portex法[(5.9±4.3)min vs.(9.9±1.5),P＜0.01].CBR法出血1例,无手术后切口处溢痰现象,Portex法出血5例,有2例在术后出现切口处溢痰现象,二者之间比较差异具有统计学意义(P＜0.05);有关操作者的调查资料显示:有外科工作经历且参与该项研究前操作例数大于20例的男医生更喜欢Portex而无外科工作经历且操作经历较少的女医生更喜欢CBR.结论 CBR法操作省时简便,在减轻手术创伤和减少并发症方面优于Portex法,且更容易被无外科工作经历的初学者掌握,值得临床推广.
목적 대비연구량충경피확장기관절개술(percutaneous dilational tracheostomy,PDT)즉경피도사확장겸기술(guidewire dilating forceps,Portex법)화개량단보확장기술(improved onestep dilation technique,the Ciaglia Blue Rhino method,CBR법)적조작시간、수술병발증급조작자괄의인군.방법 선취2013년3월지2014년02월입주수도의과대학부속복흥의원ICU,의행기관절개적환자,수궤분위Portex조화CBR조,대량조적수술시간、출혈량화수술병발증등진행비교.대삼여해항연구적조작자진행조사,순문기대량충불동조작방식적간법.결과 공유48례환자삼여료해항연구,년령(76.7±11.6)세,기중남성위25례(52.1％),행기관절개적원인위:예계궤계통기시간대우2주(30례)、중도의식장애(17례)、상기도경조(1례);삼여해항연구적환자수궤분위Portex조화CBR조,량조환자재년령、성별、입ICU적APACHEⅡ평분、기관절개적원인、기관절개전적궤계통기시간、술전적응혈공능등방면균차이무통계학의의;조작시간여수술병발증적비교결과:조작시간CBR법현저저우Portex법[(5.9±4.3)min vs.(9.9±1.5),P＜0.01].CBR법출혈1례,무수술후절구처일담현상,Portex법출혈5례,유2례재술후출현절구처일담현상,이자지간비교차이구유통계학의의(P＜0.05);유관조작자적조사자료현시:유외과공작경력차삼여해항연구전조작례수대우20례적남의생경희환Portex이무외과공작경력차조작경력교소적녀의생경희환CBR.결론 CBR법조작성시간편,재감경수술창상화감소병발증방면우우Portex법,차경용역피무외과공작경력적초학자장악,치득림상추엄.
Objective To compare the manipulation of two different methods of percutaneous dilatational tracheostomy (PDT),the guidewire dilating forceps (Portex method) and the modified onestep dilation technique (Ciaglia Blue Rhino method,CBR method).Methods From March 2013 to February 2014,48 patients eligible to meet the criteria of tracheostomy in ICU were collected and were divided into two groups at random.The length of time consumed for operation,amount of blood lost during operation and the operation complications were compared between two groups.The participant surgeons were asked which method they preferred,Portex or CBR.Results Of them,the mean age was 76.7 ± 11.6 years old,and 25 patients (52.1％) were male.The reasons for tracheotomy were the length of time needed for mechanical ventilation support expected to be longer than 2 weeks (n =30),severe disturbance of consciousness (n =17),and upper airway obstruction (n =1).The patients enrolled in the study were randomly divided into Portex and CBR groups.There were no significant differences in age,gender,APACHE Ⅱ score,the reason of tracheotomy,the length of time for mechanical ventilation support before tracheotomy,and the preoperative coagulation function between two groups.CBR method can easily be done with less operation time required than Portex [(5.9 ±4.3) min vs.(9.9 ± 1.5) min,P ＜0.01],and had obviously fewer operation complications and less amount of blood lost than Portex method (P ＜ 0.05).The male surgeons with a slew of surgical practice were in preference to Portex,whereas female doctors with less work experience and without surgical practice preferred CBR.Conclusions The CBR method can easier be done and was better than the Portex method in minimizing operative trauma and reducing the complications,especially it can easily be accepted by female doctors with less work experience and without surgical practice and it is worth using widely in clinic.