本文關(guān)鍵詞： 經(jīng)皮氣管切開術(shù) 傳統(tǒng)氣管切開術(shù) 微創(chuàng) 并發(fā)癥 神經(jīng)重癥　出處：《華北理工大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過經(jīng)皮氣管切開術(shù)(percutaneous tracheotomy,PT)與傳統(tǒng)氣管切開術(shù)在神經(jīng)重癥患者中應(yīng)用的對比,為神經(jīng)重癥患者提供一種快捷、微創(chuàng)的氣管切開方法,探討PT在神經(jīng)重癥患者中應(yīng)用的安全性。方法本研究為前瞻性對比研究,將2013年6月至2015年2月在華北理工大學(xué)附屬曹妃甸區(qū)醫(yī)院、河北省唐山市古冶區(qū)中醫(yī)院神經(jīng)外科住院治療,且符合納入標(biāo)準(zhǔn)的196例需要行氣管切開的患者分為PT組和傳統(tǒng)氣管切開組,分別記錄所有患者性別、年齡、氣管切開距發(fā)病時間、術(shù)前格拉斯哥昏迷評分(glasgow coma score,GCS)以及所患疾病等一般情況,同時記錄手術(shù)切口大小、手術(shù)操作時間、拔除氣管套管后切口愈合時間以及術(shù)中出血、術(shù)后出血、氣胸、皮下氣腫、食管損傷、切口感染、套管脫出、氣管塌陷等術(shù)中、術(shù)后并發(fā)癥,比較兩組間的差異。結(jié)果PT組與傳統(tǒng)組中所有納入標(biāo)準(zhǔn)的患者手術(shù)均成功完成。術(shù)前兩組患者各98例,在研究過程中按照排除標(biāo)準(zhǔn)術(shù)后PT組排除31例,傳統(tǒng)組排除37例。1兩組患者在性別、年齡以及氣管切開距發(fā)病時間、術(shù)前格拉斯哥昏迷評分(GCS)、所患疾病(腦血管病、顱腦損傷)比較差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。2 PT組切口大小(1.23±0.11)厘米、術(shù)中出血量(20.37±3.92)毫升、手術(shù)時間(7.63±1.00)分鐘、拔除氣管套管后切口愈合時間(3.63±0.52)天;傳統(tǒng)組切口大小(5.39±0.46)厘米、術(shù)中出血量(42.62±7.78)毫升、手術(shù)時間(41.51±3.78)分鐘、拔除氣管套管后切口愈合時間(5.89±0.95)天。兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。3 PT組術(shù)中及術(shù)后并發(fā)癥發(fā)生率[7.46%(5/67)]明顯低于傳統(tǒng)組并發(fā)癥發(fā)生率[19.67%(12/61)],兩組間比較差異有統(tǒng)計學(xué)意義(P=0.042,0.05)。結(jié)論經(jīng)皮氣管切開術(shù)符合現(xiàn)在微創(chuàng)技術(shù)的要求,與傳統(tǒng)氣管切開術(shù)相比,可在床邊操作、手術(shù)切口小、操作時間短、術(shù)中出血量少、拔除氣管套管后切口愈合時間短、并發(fā)癥發(fā)生率低,在神經(jīng)重癥患者中應(yīng)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 鹵0.11 cm. The intraoperative bleeding was 20.37 鹵3.92) ml, the operative time was 7.63 鹵1.00 minutes, and the wound healing time was 3.63 鹵0.52 days after trachea cannula was removed. In the traditional group, the incision size was 5.39 鹵0.46 cm, the intraoperative bleeding was 42.62 鹵7.78 ml, and the operative time was 41.51 鹵3.78 minutes. The wound healing time after extubation was 5.89 鹵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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R741

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本文編號：1477871