Objective To Analyze the influence factors on the complications of percutaneous dilational tracheotomy.Methods Between August 2008 and February 2014,there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy,mainly using percutaneous dilational and percutaneous guide wire forceps in these cases.Statistical analysis was performed by SPSS 19.0 software on postoperative complications,the possible influence factors including age,gender,etiology,preoperative hypoxia,obesity,preoperative pulmonary infection,state of consciousness,operation method,operation doctor and whether with tracheal intubation.Results Among 3 450 patients,there were 164 cases with intraoperative or postoperative complications,including postoperative bleeding in 74 cases (2.14％),subcutaneous emphysema in 54 cases(1.57％),wound infection in 16 cases(0.46％),pneumothorax in 6 cases (0.17％),mediastinal emphysema in 5 cases(0.14％),operation failed and change to conventional incision in 4 cases(0.12％),tracheoesophageal fistula in 2 cases (0.06％),death in 3 cases (0.09％).Obesity,etiology,preoperative hypoxia,preoperative pulmonary infection,state of consciousness and operation method were the main influence factors,with significant statistical difference (x2 value was 0.010,0.000,0.002,0.000,0.000,0.000,all P ＜ 0.05).Gender,age,operation doctor and whether there was the endotracheal intubation were not the main influence factors.There was no significant statistical difference (P ＞ 0.05).Conclusion Although percutaneous dilational tracheostomy is safe,but the complications can also happen.In order to reduce the complications,it is need to pay attention to the factors of obesity,etiology,preoperative hypoxia,preoperative pulmonary infection,state of consciousness and operation method.%目的 对经皮扩张气管切开术并发症的影响因素进行分析.方法 对天津市环湖医院2008年8月至2014年2月间3 450例有气管切开手术指征的患者行经皮扩张气管切开术,主要采用了经皮旋转扩张和经皮导丝扩张钳两种方法.采用SPSS 19.0软件对术中术后并发症发生的情况进行单因素分析.可能的影响因素包括年龄、性别、病因、术前缺氧、肥胖、术前肺部感染、意识状态、手术方法、操作医生和是否有气管插管.结果 3 450例患者中164例(4.75％)发生术中或术后并发症,其中术后出血74例(2.14％);皮下气肿54例(1.57％);伤口感染16例(0.46％);气胸6例(0.17％);纵隔气肿5例(0.14％);手术未成功改常规气管切开4例(0.12％);气管食管瘘2例(0.06％);死亡3例(0.09％).单因素分析发现,病因、肥胖、术前缺氧、术前肺感染、意识状态和手术方法是并发症发生的主要影响因素(x2值分别为0.010、0.000、0.002、0.000、0.000、0.000,P值均＜0.05),而性别、年龄、操作医生和是否有气管内麻醉插管不是并发症发生的影响因素(P值均＞0.05).结论 经皮扩张气管切开术较为安全,但也会出现并发症,其影响因素包括病因、肥胖、术前缺氧、术前肺部感染、意识状态和手术方法,需要注意以上影响因素的预防,从而减少并发症的发生.
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