摘要：

目的: 对比分析直视下经皮扩张气管切开术与标准经皮扩张气管切开术治疗神经外科重症患者的安全性。方法: 共纳入2012年1月至2021年12月在苏州大学附属第二医院行气管切开术的420例神经外科重症患者，分别采用标准经皮扩张气管切开术（257例）和直视下经皮扩张气管切开术（163例）。记录手术时间，以及术中严重出血、低氧、心跳骤停和术后皮下气肿、气胸、纵隔气肿、气管切开套管误入气管外间隙、气管后壁损伤、切口感染等并发症发生率。结果: 直视下经皮扩张气管切开术手术时间长于标准经皮扩张气管切开术[（21.74 ± 2.90）min对（12.74 ± 1.96）min；t = 38.050，P = 0.000]。标准经皮扩张气管切开术组并发症发生率为7.78%（20/257），分别为术中严重出血5例（1.95%）以及术后皮下气肿4例（1.56%）、气胸1例（0.39%）、纵隔气肿2例（0.78%）、气管切开套管误入气管外间隙2例（0.78%）、气管后壁损伤3例（1.17%）、切口感染3例（1.17%）；直视下经皮扩张气管切开术组并发症发生率为4.29%（7/163），分别为术中严重出血1例（0.61%）以及术后皮下气肿2例（1.23%）、纵隔气肿2例（1.23%）、气管切开套管误入气管外间隙1例（0.61%）、切口感染1例（0.61%），两组并发症发生率差异无统计学意义（χ² = 2.017，P = 0.156）。结论: 直视下经皮扩张气管切开术可在标准经皮扩张气管切开术使用受限的神经外科重症患者中有效展开，操作简便，具备微创优势，且并未增加并发症发生率。

关键词: 危重病人医疗, 神经外科（学）, 气管切开术, 手术后并发症

Abstract:

Objective: To contrastive analyze the safety of percutaneous dilated tracheotomy under direct vision (PDTUDV) compared with standard percutaneous dilated tracheotomy (PDT) in severe neurosurgical patients. Methods: A total of 420 severe neurosurgical patients were included from January 2012 to December 2021, with 163 cases received percutaneous dilated tracheotomy under direct vision and 257 cases received standard percutaneous dilated tracheotomy. Operation time, as well as complication rates of severe intraoperative bleeding, low oxygen, cardiac arrest, and subcutaneous emphysema, pneumothorax, mediastinal emphysema, tracheal catheter entering the outer airway space, posterior tracheal wall injury and incision infection were recorded. Results: Percutaneous dilated tracheostomy under direct vision operation time was longer than standard percutaneous dilated tracheostomy [(21.74 ± 2.90) min vs. (12.74 ± 1.96) min; t = 38.050, P = 0.000]. The complication rate in the standard percutaneous dilation tracheostomy group was 7.78% (20/257), 5 cases (1.95%) with severe intraoperative bleeding, 4 cases (1.56%) with subcutaneous emphysema, one case (0.39%) with pneumothorax, 2 cases (0.78%) with mediastinal emphysema, 2 cases (0.78%) with tracheal catheter entering the outer airway space, 3 cases (1.17%) with posterior tracheal wall injury, and 3 cases (1.17%) with incision infection; the complication rate of percutaneous dilated tracheostomy under direct vision group was 4.29% (7/163), one case (0.61%) with severe intraoperative hemorrhage, 2 cases (1.23%) with subcutaneous emphysema, 2 cases (1.23%) with mediastinal emphysema, one case (0.61%) with tracheal catheter entering the outer airway space, one case (0.61%) with incision infection, there was no significant difference in the complication rate between 2 groups (χ² = 2.017, P = 0.156). Conclusions: Percutaneous dilated tracheostomy under direct vision can be effectively used in severe neurosurgical patients with standard percutaneous dilation tracheostomy uesd limited. It is easy to operate, minimally invasive, and does not increase the complication rate.

Key words: Critical care, Neurosurgery, Tracheotomy, Postoperative complications