超声引导下经皮扩张气管切开术在老年危重患者中的应用

Ultrasound-guided percutaneous dilatational tracheostomy in elderly critical ill patients

目的探讨老年危重患者使用超声引导进行经皮扩张气管切开(PDT)的有效性和安全性。方法回顾性分析2013年8月至2014年7月复旦大学附属中山医院外科监护室行PDT的老年患者(>65岁)55例,根据气管切开操作时引导方式不同分为纤支镜组(35例)和超声组(20例),分别记录并比较两组患者手术操作时间、术中及术后出血、术后各类并发症、住院时间及死亡率等情况。结果超声组患者手术时间比纤支镜组短(12.3±4.8vs.15.2±3.4min,P=0.023),术中出血量也少于纤支镜组(9.3±3.8 vs.12.8±2.3 mL,P=0.005)。两组患者术中低氧血症、术后出血、气管狭窄等并发症无统计学差异,重症监护室(ICU)及总住院时间和死亡率亦无统计学差异。结论超声引导下PDT可有效缩短气管切开术时间并减少术中出血,可为老年危重症患者快速、安全、精确开放气道的首选方式。

Objective To evaluate the efficiency and safety of ultrasound-guided percutaneous dilatational tracheostomy （PDT） in elderly critical ill patients. Methods From August 2013 to July 2014, 55 elderly patients （〉65y） in the intensive care unit in the Zhongshan hospital received PDT. Thirty five patients was guided by bronchofibroscope （Group B）, while 20 patients guided by ultrasound （Group U）. The operation time, hyoxemia during the surgery, volume of bleeding and the other complications were recorded. Resnlts The operation time in the group U was significantly shorter than that in the group B （12.3±4.8 vs. 15.2±3.4 min, P=0.023） and the volume of bleeding during the surgery in the group U was less than that in the group B （9.3±3.8 vs. 12.8±2.3 mL, P=0.005）. There were no significant differences in the complications and the length of hospital stay between the two groups. Conclusion Ultrasound-guided PDT could shorten the operation time and reduce the blood loss during the surgery which was a good option for elderly critical ill patients.