目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
Objective To explore the influence of different withdrawal time of trachea cannula on percutaneous dilational tracheostomy (PDT) in critically ill patients. Methods In this study, we retrospectively analyzed the clinical data of 185 critically ill patients experienced PDT, who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University from January 2015 to July 2017. The patients were divided into an early PDT group (EPDT group) and a delayed PDT group (DPDT group) according to the timing of withdrawing trachea cannula. Operation information such as operation time, blood loss and the incidence of complications were collected and compared between the two groups. Results Between the EPDT group and the DPDT group, there were no obvious differences in operation time (minutes: 6.5±2.6 vs. 7.3±3.5), amount of blood loss (ml: 5.2±2.8 vs. 6.0±3.4) or conversion to traditional operation (1.9% vs. 2.4%) (all P>0.05). Compared with the EPDT group, the DPDT group patients experienced more fluctuation of intraoperative vital signs, used more dose of sedative and analgesic drugs, and experienced higher occurrence of aspiration (18.3%vs. 5.6%), balloon burst (13.4% vs. 2.9%), guide-wire placing difficulty (11.0% vs. 1.9%) and tracheostomy cannula placing difficulty (14.6% vs. 2.9%) (all P<0.05). There were no statistical significances in postoperative complications such as postoperative-hemorrhage, pneumothorax, pneumoderm, the posterior tracheal injury or incision infection between the two groups (allP<0.05). More patients acquired postoperative pulmonary infection in the DPDT group than the EDPD group (12.2%vs. 5.8%, P>0.05), and there was no statistical significances in mechanical ventilation time between the two groups (days: 5.5±3.0vs. 6.0±2.5, P>0.05). Conclusions The operation and complications of PDT in critically ill patients are influenced by the timing of withdrawing trachea cannula. The standard procedure of withdrawing trachea cannula preoperatively may offer better clinical operability and lower technical risk.