超声引导下经皮气管切开术在危重症患者人工气道建立中的临床应用

Clinical Application of Ultrasound Guided Percutaneous Dilational Tracheotomy in Establishment of Artificial Airway for Critically ill Patients

目的:探讨超声引导下经皮气管切开术(PDT)在危重症患者人工气道建立中的临床应用效果。方法:选取2016年3月至2017年4月90例重症监护室(ICU)危重症患者,均行PDT建立人工气道,利用数字表将其随机分为两组,各45例,A组采取超声引导方式,B组采取纤维支气管镜辅助方式,比较两组手术指标、气管插管情况、术后恢复指标及并发症发生率。结果:A组手术时间短于B组(P<0.05),出血量少于B组(P<0.05),且气囊漏气率低于B组(P<0.05);两组手术切口长度、术中低氧血症发生率、首次插管成功率、气管插管退至间隔门齿距离、术后脱机时间、拔管时间、ICU住院时间、总住院时间及术后并发症总发生率比较无明显差异(P>0.05)。结论:相较于纤维支气管镜,人工气道建立中实施超声引导下PDT,具有缩短手术时间、降低术中出血量与气管插管气囊漏气率的优势,具有较高安全性、精准性。

Objective:To observe the clinical application effect of ultrasound guided percutaneous dilational tracheostomy(PDT)in establishment of artificial airway for critically ill patients.Methods:90 critically ill patients in intensive care unit(ICU)from March 2016 to April 2017 were selected,and PDT was performed in establishment of artificial airway.They were randomly divided into 2 groups,45 cases in each group.Group A was treated by ultrasound guided PDT,while group B was treated by fiber bronchoscope assisted PDT.The operative indexes,tracheal intubation,postoperative recovery indexes and incidence of complications were compared between the 2 groups.Results:The operative time,bleeding volume and air leakage rate of air bag in group A were shorter/less/lower than those in group B(P<0.05).There was no significant difference between the 2 groups in the length of incision,the incidence of intraoperative hypoxemia,the success rate of initial intubation,the distance of tracheal intubation backing to the incisor,postoperative weaning time,extubation time,length of stay in ICU,total length of stay hospital or total incidence rate of postoperative complications(P>0.05).Conclusion:Compared with fiber bronchoscope,ultrasound guided PDT in establishment of artificial airway can shorten the operative time and decrease the bleeding volume and air leakage rate of tracheal intubation during operation,and it has high safety and accuracy.