經皮氣管切開術在加護病房重症患者的運用

Percutaneous Dilatational Tracheostomy in Critically Ill Patients in Intensive Care Units

張旭良(Hsu-Liang Chang) ； 楊志仁(Chih-Jen Yang) ； 洪仁宇(Jen-Yu Hung) ； 洪加芬(Chia-Fen Hung) ； 蘇育正(Yu-Chung Su) ； 鍾飲文(Inn-Wen Chong) ； 黃吉志(Jhi-Jhu Hwang) ； 黃明賢(Ming-Shyan Huang) ； 許超群(Chau-Chyun Sheu) ； 蔡忠榮(Jong-Rung Tsai)

《內科學誌》 24卷3期 (2013/06) Pp. 153-161

https://doi.org/10.6314/JIMT.2013.24(3).01

摘要

重症病人當中，以急性呼吸衰竭占了多數。初期可經喉插管置入氣管內管來解決問題，一旦需要長期使用呼吸器，氣管切開術仍是不可避免之處置。隨著醫療技術的發展與進步，為了病人的安全及兼顧效率，不斷有人尋求更簡單有效的方法，故經皮氣管切開術因應而生。許多研究顯示，與傳統外科執行之氣管切開術（Open standard tracheostomy）相比較，經皮氣管切開術（Percutaneous dilatational tracheostomy）之併發症及手術相關死亡率並不會增加。經皮氣管切開術可直接在病人床邊執行，大大增進效率。本篇將就經皮氣管切開術的發展史，施行步驟、適應症、禁忌症、相關併發症、與傳統氣管切開術的比較等，加以討論說明，並分享本院執行經皮氣管切開術之經驗。

關鍵字

經皮氣管切開術 ； 藍犀牛氣管引導器組

並列摘要

Patients with acute respiratory failure account for the majority of critically ill patients in the intensive care unit. Initial intubation with an endotracheal tube through the larynx resolves acute respiratory failure. However, if long-term ventilator dependence is required, the tracheostomy is necessary. With the development of medical technology with regards to patient safety, research has continued on more effective and simple methods. One such method is percutaneous tracheostomy, which can be performed directly at the patient's bedside which greatly improve efficiency. Many studies have shown that there are no significant differences in complications and mortality between traditional surgical tracheostomy and percutaneous dilatational tracheostomy. This article examines the development, steps, indications, contraindications, and complications of percutaneous dilatational tracheostomy, and compares it to traditional tracheostomy. We also share our experience of percutaneous tracheostomy.

並列關鍵字

Percutaneous dilatational tracheostomy ； PDT ； Ciaglia Blue Rhino Percutaneous Tracheostomy Introducer Set