纤维支气管镜引导下经皮气管切开术在重症监护病房中的应用

Application of Percutaneous Tracheotomy Guided by Fiberoptic Bronchoscope in Intensive Care Unit

目的:比较在重症监护病房中纤维支气管镜(简称纤支镜)引导下的经皮气管切开术与无纤支镜辅助的经皮气管切开术的手术操作时间、围手术期和术后远期并发症的发生情况。方法:回顾分析江苏省常熟市第一人民医院重症监护病房2010年11月—2014年1月收治的73例气管切开患者的临床资料。根据有无纤支镜辅助将73例分为纤支镜引导下的经皮气管切开术组(A组,n=43)与无纤支镜辅助的经皮气管切开术组(B组,n=30),比较2组在经皮气管切开术中和术后近期及远期并发症发生情况。结果:2组手术操作时间差异无统计学意义(P>0.05)。A组围手术期发生并发症4例,其中术后渗血>48 h、切口感染各1例,皮下气肿2例;B组围手术期发生并发症15例,其中气胸、切口感染各1例,术后渗血>48 h3例,皮下气肿5例,气管后壁、侧壁损伤5例。2组并发症发生率的差异有统计学意义(P<0.05)。73例患者中33例得到随访。A组18例得到随访,其中仅2例发生并发症,1例诉声音嘶哑,1例喉部异物感。B组15例得到随访,其中2例发生并发症,1例诉声音嘶哑,1例吞咽困难。2组远期并发症发生率差异无统计学意义(P>0.05)。结论:在纤支镜引导下行经皮气管切开术并不增加手术时间,但可降低围手术期并发症。

Objective：To compare the operation time,peroperative and long-term postoperative complications of percutaneous tracheotomy with or without the guidance by fiberoptic broncho-scopy in intensive care unit（ICU）.Methods：The clinical data of73 patients who were performed percutaneous tracheotomy in ICU of Changshu First People＇s Hospital from Nov 2010 to Jan2014 were retrospectively analyzed.Forty-three patients who accepted percutaneous tracheotomy guided by fiberoptic bronchoscopy were assigned to Group A,while the other 30 patients were assigned to Group B.The status of intraoperative and shortterm and long-term postoperative complications were compared between the two groups.Results：The operation time had no significant difference between the two groups（P〉0.05）.Four cases（9.3%）in Group A got perioperative complications,including 1 case of postoperative bleeding 〉48 h,1 case of wound infection and 2 cases of subcutaneous emphysema.Fifteen cases（50%）in Group B got perioperative complications,including 1 case of wound infection,1 case of pneumothorax,3 cases of postoperative bleeding 〉48 h,5 cases of subcutaneous emphysema,and 5 cases of tracheal damage on posterior wall or side wall.The differences in rate of complications between the two groups were statistically significant（P〈0.05）.Among the 73 patients,33 cases had be followed up,2 cases from the 18 cases who had be followed up in Group A had complications,including 1 case of hoarseness,1 case of foreign body sensation in the throat.Two cases from the 15 cases who had be followed up in Group B had complications,including 1 case of hoarseness,1 case of dysphagia.The long-term complications rates had no significant difference between the two groups（P〉0.05）.Conclusions：The percutaneous tracheotomy guided by fiberoptic bronchoscopy does not increase operation time,but can reduce the incidence of perioperative complications.