Clinical Value of Percutaneous Dilatational Tracheotomy in Cardiosurgery / 中国微创外科杂志

ABSTRACT

Objective To discuss the value of percutaneous dilatational tracheotomy(PDT) for cardiosurgery in intensive care unit by comparing its outcomes with that of open tracheotomy(OT).MethodsA prospective study was conducted on 40 severe patients undergoing cardiosurgery.The patients were divided into PDT(treated from January 2002 to July 2003) and OT groups(treated from August 2003 to February 2008) with 20 cases in each.The operation time,length and heal time of the incision,blood loss,vital signs,and postoperative complications were compared between the two groups.ResultsThe operation time,length and heal time of the incision in the PDT group were significantly different from that in the OT group [(8.8?2.2) min vs(21.5?5.3) min,t=-9.897;(1.3?0.2) cm vs(3.4?0.5) cm,t=-17.440;and(3.9?0.9) d vs(5.9?1.2) d,t=-5.963;P=0.000].One patient in the PDT group(5%) had Ⅱ degree blood loss during the operation that was significantly less than those in the OT group(13 patients,65%,?2=15.824,P=0.000).The level of the vital signs change in the PDT group was significantly milder than those in the OT group [MAP 1-5 mm Hg(median 2) vs 1-20 mm Hg(median 3.5),Z=-2.959,P=0.003;heart rate 3-12 beats/min(median 5.5) vs 7-70 beats/min(median 10),Z=-3.956,P=0.000;SpO2 0-4%(median 2%) vs 0-31%(median 3.5%),Z=-3.548,P=0.000].Furthermore,the rate of incisional leakage of sputum and overall rate of complications in the PDT group were significantly lower than those in the OT group.[1(5%) vs 8(40%),?2=5.161,P=0.023;and 1(5%) vs 12(60%),?2=13.789,P=0.000].ConclusionsPDT is a safe and minimally invasive technique with a high rate of success and low rate of complications.The method is easy to operate,and thus could be a good choice for severe patients after cardiovascular surgeries.