超声评估纤维支气管镜引导下气管切开的临床研究

Clinical study of ultrasound evaluation of fiberoptic bronchoscope guided tracheotomy

目的探讨超声评估纤维支气管镜(纤支镜)引导下气管切开的临床应用效果,为困难气管切开及新人操作提供帮助.方法规范超声评估纤支镜引导下气管切开操作流程,按照此流程对2019年10月至2020年1月东阿县人民医院重症医学科收治的10例困难气管切开患者,用超声评估方法指导纤支镜引导下气管切开,记录气管切开过程中的出血量、手术时间及相关并发症等.结果通过对超声评估纤支镜引导下气管切开用品准备、人员准备、患者准备、操作准备、操作过程等进行标准化.为困难气管切开患者进行气管切开时,需先用超声来评估患者颈部情况及血管走形,并设计气管切开方案(气管切开部位、切口大小、切开深度),然后在纤支镜可视化引导下监控气管切开过程.10例困难气管切开患者中男性6例,女性4例;体重指数(32.2±1.4)kg/m2.10例患者在超声评估纤支镜引导下气管切开过程顺利,均在10 min内完成手术,出血量均少于5 mL,且无并发症发生.结论超声评估纤支镜引导下气管切开可让临床操作更加顺利,保证患者安全.

Objective To explore the clinical effect of ultrasound evaluation of fiberoptic bronchoscope(FB)guided tracheotomy,which can provide help for difficult tracheotomy and new operators.Methods The operating protocol was standardized for ultrasound evaluation of FB guided tracheotomy.Ten patients with difficult tracheotomy admitted to the department of critical care medicine of Donge Hospital from October 2019 to January 2020 were enrolled.According to this protocol,FB guided tracheotomy was performed under the ultrasound evaluation,and the amount of blood loss,operation time and related complications during procedures were collected.Results The preparation of supplies,personnel,patients and the operation,the process of FB guided tracheotomy under the ultrasound evaluation were standardized.When tracheotomy was preformed for patients with difficult tracheotomy,it was necessary to use ultrasound first to evaluate the neck condition and vascular disorientation of patients,and the tracheotomy plan(tracheotomy site,incision size,and incision depth)was designed,and then the tracheotomy process was monitored under the guidance of FB.Among the 10 patients with difficult tracheotomy,6 were male and 4 were female;body mass index was(32.2±1.4)kg/m2.Tracheotomy was successfully completed within 10 minutes in all the 10 patients,with less than 5 mL blood loss,and no complications occurred.Conclusion Ultrasound evaluation of FB guided tracheotomy can improve the clinical operations and ensure patient safety.