关键词: 经皮扩张气管切开术, 支气管镜, 并发症, 经皮导丝扩张钳气管切开术, 经皮旋转扩张气管切开术, 神经外科

Abstract: Objective To evaluate the feasibility and safety of 182 patients underwent percutaneous tracheotomy using the guide wire dilation forceps(GWDF) techniques and the Percutwist technique without the assistance of bronchoscopy in intensive unit from the year 2002～2006.Methods 182 patients underwent the Percutaneous Dilative Tracheostomy(PDT) in ICU of Tiantan hospital.Most of them are transferred from the neurosurgical department of our hospital.A 3 months' follow-up visit was performed(except the dead cases).The first 152 patients underwent PDT by using the GWDF techniques Kit,and the remaining 30 patients underwent PDT by using the PercuTwist tracheotomy Kit.Results All the cases have a successful cannulation.Non of them was conversed to the conventional open tracheostomy technique.The mean operating duration of GWDF was 4～5 minutes.The mean operating durations of Percutwist was 8.5 minutes,the duration of practician was 6～7 minutes and the duration of unpratician was about 10 minutes in Percutwist technique.Overall,the two most common complications were peristomal hemorrhage in 6 cases and wound infection in 2 cases.1 cases of pneumoderma was found.During the 3 months' follow-up visit,there were no complications of pneumothorax,tracheo-esophageal fistula,symptomatic tracheal stenosis and operating-related death.No symptomatic tracheal stenosis was found.The total complication rate of PDT in our ICU was 4.95%.The total complication rate abroad was 6.23%.11 cases dead form other reasons which was not relate to PDT.The incidence of complications were similar to the relevant domestic and abroad literatures,some complications were even lower than the literatures abroad.The absence of serious complications such as pneumothorax symptomatic tracheal stenosis and pneumomediastinum are attributable to identify the anatomic landmark strictly,ensure the smooth gliding movement of the J guide wire in each step of the operation,never use brute force downward to the trachea.Conclusion The PDT without the assistance of bronchoscopy is feasible and safe.The operator should be careful,obey the contraindication strictly,improve the techniques and skills,never use brute force downward to the trachea.The severe complications of the PDT were not relate to the use or not use of the bronchoscopy.If the PDT kit can be improved to adapt the circumstance of non bronchoscopic assistance,it will be more popular.

Key words: percutaneous dilational tracheostomy, bronchoscopy, complication, guide wire dilation forceps, percutwist, neurosurgery