困难条件新型冠状病毒肺炎患者行经皮扩张气管切开术1例体会

Experience of percutaneous dilatation tracheotomy in one case with coronavirus disease 2019 under difficult conditions

2019年12月以来,由新型冠状病毒(2019-nCoV)感染导致的新型冠状病毒肺炎(COVID-19)在中国流行,并在世界范围内蔓延。COVID-19以发热、乏力和干咳为主要表现,重型患者可快速进展为急性呼吸窘迫综合征(ARDS)。氧疗是COVID-19的重要治疗手段,对于危重型患者,经常需要有创机械通气。我们对1例困难条件COVID-19患者经皮扩张气管切开术(PDT),所有参与者按三级防护标准进行防护。对危重型COVID-19患者,是否进行气管切开术需由重症监护医师综合多因素考虑。对重症监护医师来说,PDT是安全、方便的选择。对于颈部条件不好的患者,可以请耳鼻咽喉科医师协助或采取超声引导下PDT。手术过程中确保患者处于完全肌松状态,避免喷溅分泌物。

Since December 2019,coronavirus disease 2019(COVID-19)caused by 2019 novel coronavirus(2019-nCoV)infection has been epidemic in China and spreading worldwide.The main manifestations of COVID-19 are fever,weakness and dry cough.Severe cases may progress to acute respiratory distress syndrome rapidly.Oxygen therapy is an important treatment for COVID-19.For critically ill patients,invasive mechanical ventilation is often required.The authors participated in percutaneous dilatation tracheotomy(PDT)on one case with COVID-19 under difficult conditions.All participants were protected according to the third level of personal protection.For critically ill cases,whether to perform tracheotomy should be considered by ICU physicians.PDT is a safe and convenient option for ICU physicians.When performing PDT on patients with poor neck conditions,otolaryngologist will be a right assistant.Ultrasound-guided PDT is another good option.During the operation,the patient should be in the state of complete muscle relaxation to avoid spillage.