经皮气管切开术与传统气管切开术在神经重症患者中应用的对比研究

发布时间：2018-01-31 02:01

本文关键词： 经皮气管切开术传统气管切开术微创并发症神经重症　出处：《华北理工大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的通过经皮气管切开术(percutaneous tracheotomy,PT)与传统气管切开术在神经重症患者中应用的对比,为神经重症患者提供一种快捷、微创的气管切开方法,探讨PT在神经重症患者中应用的安全性。方法本研究为前瞻性对比研究,将2013年6月至2015年2月在华北理工大学附属曹妃甸区医院、河北省唐山市古冶区中医院神经外科住院治疗,且符合纳入标准的196例需要行气管切开的患者分为PT组和传统气管切开组,分别记录所有患者性别、年龄、气管切开距发病时间、术前格拉斯哥昏迷评分(glasgow coma score,GCS)以及所患疾病等一般情况,同时记录手术切口大小、手术操作时间、拔除气管套管后切口愈合时间以及术中出血、术后出血、气胸、皮下气肿、食管损伤、切口感染、套管脱出、气管塌陷等术中、术后并发症,比较两组间的差异。结果PT组与传统组中所有纳入标准的患者手术均成功完成。术前两组患者各98例,在研究过程中按照排除标准术后PT组排除31例,传统组排除37例。1两组患者在性别、年龄以及气管切开距发病时间、术前格拉斯哥昏迷评分(GCS)、所患疾病(脑血管病、颅脑损伤)比较差异无统计学意义(P0.05),具有可比性。2 PT组切口大小(1.23±0.11)厘米、术中出血量(20.37±3.92)毫升、手术时间(7.63±1.00)分钟、拔除气管套管后切口愈合时间(3.63±0.52)天;传统组切口大小(5.39±0.46)厘米、术中出血量(42.62±7.78)毫升、手术时间(41.51±3.78)分钟、拔除气管套管后切口愈合时间(5.89±0.95)天。两组比较差异有统计学意义(P0.05)。3 PT组术中及术后并发症发生率[7.46%(5/67)]明显低于传统组并发症发生率[19.67%(12/61)],两组间比较差异有统计学意义(P=0.042,0.05)。结论经皮气管切开术符合现在微创技术的要求,与传统气管切开术相比,可在床边操作、手术切口小、操作时间短、术中出血量少、拔除气管套管后切口愈合时间短、并发症发生率低,在神经重症患者中应用快捷、具有一定的安全性。
[Abstract]:Objective to compare the application of percutaneous tracheotomy PTT and traditional tracheotomy in patients with severe neurological diseases. To provide a rapid and minimally invasive tracheotomy for neurotic patients and to explore the safety of PT in neurotic patients. Methods this study is a prospective comparative study. From June 2013 to February 2015 in Caofeidian District Hospital affiliated to North China University of Science and Technology, Guye District, Tangshan City, Hebei Province, Neurosurgery Department of Neurosurgery was hospitalized. 196 patients with tracheotomy were divided into PT group and traditional tracheotomy group. The sex, age and time of tracheotomy were recorded respectively. The preoperative Glasgow coma score and the general condition of the disease were also recorded. The size of the incision and the time of operation were recorded at the same time. Postoperative complications included wound healing time and bleeding, postoperative bleeding, pneumothorax, subcutaneous emphysema, esophageal injury, incision infection, trocar prolapse, trachea collapse and so on. Results all the patients in the PT group and the traditional group were successfully operated. There were 98 patients in each group before operation and 31 patients in the PT group were excluded according to the exclusion criteria in the course of the study. In the traditional group, 37 cases were excluded. 1 patients of both groups were excluded in sex, age, tracheotomy and onset time. Glasgow coma score (Glasgow coma score) before operation and the disease (cerebrovascular disease) were excluded. There was no significant difference in craniocerebral injury (P 0.05). The incision size of PT group was 1.23 卤0.11 cm. The intraoperative bleeding was 20.37 卤3.92) ml, the operative time was 7.63 卤1.00 minutes, and the wound healing time was 3.63 卤0.52 days after trachea cannula was removed. In the traditional group, the incision size was 5.39 卤0.46 cm, the intraoperative bleeding was 42.62 卤7.78 ml, and the operative time was 41.51 卤3.78 minutes. The wound healing time after extubation was 5.89 卤0.95days. There was significant difference between the two groups in the incidence of intraoperative and postoperative complications in P0.053.PT group. [The incidence of complications in the traditional group was significantly lower than that in the traditional group. [The difference between the two groups was statistically significant. Conclusion Percutaneous tracheotomy meets the requirement of minimally invasive technique. Compared with the traditional tracheotomy, it can be operated on the bedside, the operation incision is small, the operation time is short, the amount of bleeding is less, the wound healing time is short after trachea cannula is removed, and the incidence of complications is low. It can be used quickly and safely in patients with severe neurological diseases.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R741

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