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Crit Care:危重病人经皮气管切开术是选择垂直还是横向皮肤切口?

2018-10-03 xing.T MedSci原创

由此可见,这项回顾性研究显示重症患者PT的横向皮肤切口导致整体并发症显著减少,尤其是气管切开术部位的溃疡。

经皮气管切开术(PT)是重症监护医学中的常用的手术。没有明确的临床实践指南建议危重病人气管切开术时选择垂直还是横向皮肤切口方向。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,这项回顾性研究的目的是比较接受PT的患者垂直和横向皮肤切口的相关结局。

2011年3月至2015年12月期间在三级医院重症监护室(ICU)接受PT治疗的患者被回顾性地纳入研究。由ICU肺科重症监护医生使用通过柔性支气管镜辅助的单锥形扩张器技术在ICU床边进行PT。主要结局是PT后第7天气管切开术部位溃疡的发生率。

在接受PT治疗的458例患者中,垂直切口占27.1%,横切口占72.9%。没有发生与气管切开术相关的死亡病例,并且术后即刻并发症的发生率没有显著差异,包括出血、气管环骨折和皮下气肿。在PT后7天内,35名患者(7.6%)出现并发症,其中气管切开术相关的压疮最常见。与垂直切口相比,横切口的并发症发生率显著降低(14.1% vs. 5.4%,P=0.001)。

由此可见,这项回顾性研究显示重症患者PT的横向皮肤切口导致整体并发症显著减少,尤其是气管切开术部位的溃疡。

原始出处:

Sung Yoon Lim.et al.Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study.Critical Care.2018.https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2174-y

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    2018-12-09 jyzxjiangqin

    危重病人的治疗。

    0

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    2018-11-28 jyzxjiangqin

    危重病人经气管切开术。

    0

  5. 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  6. 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    2018-11-14 jyzxjiangqin

    危重病人的治疗。

    0

  7. 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    2018-11-04 jyzxjiangqin

    危重病人经皮气管疾病切开术。

    0

  8. 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    2018-10-22 jyzxjiangqin

    危重病人的治疗。

    0

  9. 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    2018-10-12 jyzxjiangqin

    危重病人气管切开。

    0

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  连日来,浙江大学医学院附属第一医院采用人工肝和人工膜肺(ECMO)技术救治危重病人,为患者带来转机。目前,该院有7位病人同时使用人工肝和体外膜肺系统,病情趋于稳定。  H7N9禽流感病毒能够迅速侵害人体肺部,重症患者常常会在短时间内出现致命的多器官衰竭。该院创新性应用人工肝、人工膜肺技术治疗,为器官衰竭患者赢得宝贵的抢救时间。  人感染禽流感病人血液中炎症因子明显升高,应用传染病诊治国家重点实

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