下颌提拉平卧位下床旁老年患者经皮扩张气管切开的安全性探讨

doi:10.6040/j.issn.1673-3770.0.2024.254

摘要/Abstract

摘要： 目的探讨病房床旁老年患者经皮扩张气管切开术(percutaneous dilatational tracheostomy, PDT)进行下颌提拉平卧位下的可行性和安全性。方法回顾性分析244例老年患者资料,病床旁分别采用颌提拉平卧位PDT(mandibular lift PDT, ML-PDT)、仰卧垫肩位PDT(shoulder cushion PDT, SC-PDT)和仰卧垫肩位常规开放式气管切开术(surgical tracheotomy, ST),比较手术切口、手术时间、并发症;并记录人口统计学特征和结果。结果男性患者多于女性,平均(82.8±7.2)岁,所有患者均顺利完成气管切开手术。ML-PDT组和SC-PDT组患者对比ST组手术切口长度(P=0.002)、手术时间平均值(P=0.002)明显低于ST组,差异有统计学意义(P<0.05);ML-PDT组与SC-PDT组间比较(P_切口长度=0.140、P_手术时间=0.162)差异无统计学意义(P>0.05)。ML-PDT组、SC-PDT组与ST组相比,出血(P=0.007)、皮下气肿(P=0.001)、术中及术后的一般并发症(P<0.001)和总并发症发病率(P<0.001)均明显降低,差异有统计学意义(P<0.05),ML-PDT与SC-PDT组间比较(P出血=1.000、P皮下气肿=1.000、P一般并发症=0.701、P_总并发症=0.605)差异无统计学意义(P>0.05);意外脱管(P=0.447)、套管气囊漏气(P=0.623)、切口感染(P=0.156)及肉芽(P=0.156)3组间比较差异无统计学意义(P<0.05)。结论老年患者床旁,下颌提拉平卧位下PDT,无需垫肩仰头体位改变,操作迅速、简单,术中和术后并发症少,安全可行。

关键词: 平卧位, 下颌提升, 老年, 经皮扩张气管切开术

Abstract: Objective To study the feasibility and safety of percutaneous dilatational tracheotomy(PDT)at the bedside in elderly patients with mandibular lift in the horizontal position. Methods We retrospectively compared different tracheotomy methods with regard to the surgical incision length, procedure duration and safety of the procedure and complications. A total of 244 elderly patients in the wards underwent PDT, with mandibular lift in the horizontal position(ML-PDT)or with shoulder cushion in supine shoulder cushion position(SC-PDT)and conventional open surgical tracheotomy with supine shoulder cushion position(surgical tracheotomy, ST). The demographic characteristics and outcomes were recorded. Results There were more male patients than females, with a mean age of(82.8±7.2)years, and all patients successfully completed tracheostomy. The mean value of surgical incision length(P=0.002)and procedure duration(P=0.002)in the ML-PDT group and in SC-PDT group was significantly lower than those in the ST group, with a statistically significant difference(P<0.05). There was no difference(P>0.05)between ML-PDT and SC-PDT groups(P_{surgical incision length}=0.140, P_{procedure duration}=0.162). Bleeding(P=0.007)and subcutaneous emphysema(P<0.001)and morbidity of complications(P<0.001)were significantly reduced significantly lower in ML-PDT group and SC-PDT group compared with in ST group, the difference was statistically significant(P<0.05). There were no differences(P>0.05)between ML-PDT and SC-PDT groups(P_bleeding=1.000、P_{subcutaneous emphysema}=1.000、P_{general complications}=0.701、P_{total complications}=0.605). Accidental decannulation(P=0.447), accidental destubes air leak from the fistula(P=0.623), incision infection(P=0.156)and granulation(P=0.156)were also lower in ML-PDT group and SC-PDT group, however, there was no significant difference statistically among the three groups(P>0.05). Conclusion PDT with mandibular lift in the horizontal position can be performed on the bedside in elderly patients without shoulder cushion to tilt the head position change. The operation is rapid and simple, intraoperative and postoperative complications are few, which is safe and feasible.

Key words: Supine position, Mandibular lift, The elderly, Percutaneous dilatational tracheostomy

中图分类号:

R762

李辉,赵永强,贺祯,杨惠敏,赵叶,田秀娟,陈剑秋. 下颌提拉平卧位下床旁老年患者经皮扩张气管切开的安全性探讨[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 87-93.

LI Hui, ZHAO Yongqiang, HE Zhen, YANG Huimin, ZHAO Ye, TIAN Xiujuan, CHEN Jianqiu. Safety of bedside percutaneous dilational tracheotomy for elderly patients with mandibular lift in the supine position[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 87-93.

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