可弯曲支气管镜联合颈部超声在婴幼儿经皮扩张气管切开术中的临床应用

Clinical application of flexible bronchoscopy and neck ultrasound in percutaneous dilatational tracheotomy in infants

目的探讨可弯曲支气管镜联合颈部超声在婴幼儿经皮扩张气管切开术中的应用价值。方法回顾性分析2018年12月至2021年5月山东大学附属儿童医院呼吸介入科收治的24例应用可弯曲支气管镜联合颈部超声经皮扩张气管切开患儿的临床资料。24例患儿中, 男12例, 女12例, 男女比例为1∶1;年龄21 d~2岁, 中位年龄5个月;中位体质量5.8 kg。在进行经皮扩张气管切开时, 先使用超声评估患儿甲状腺位置及血管走形, 选择合适穿刺入路并标记穿刺点, 然后在可弯曲支气管镜引导下完成经皮扩张气管切开术。结果术前接受持续气管插管机械通气支持治疗患儿19例(79.2%), 间断气管插管机械通气支持治疗患儿2例(8.3%), 无创呼吸机支持治疗3例(12.5%)。24例患儿中, 先天性上呼吸道发育畸形9例(37.5%);双侧声带麻痹8例(33.3%);上呼吸道占位性疾病3例(12.5%);外科术后撤机困难2例(8.3%);神经肌肉疾病2例(8.3%)。24例患儿均在30 min内成功完成手术, 出血量均少于5 mL, 术中无并发症发生。结论可弯曲支气管镜联合颈部超声辅助使婴幼儿经皮扩张气管切开术能够顺利完成, 并显著降低手术操作难度, 提高了手术的安全性。

Objective To investigate the value of flexible bronchoscopy and neck ultrasound in percutaneous dilatational tracheotomy(PDT)in infants.Methods The clinical data of 24 patients,who underwent flexible bronchoscopy and neck ultrasound assisted PDT in the Center for Respiratory Intervention,Children′s Hospital Affiliated to Shandong University from December 2018 to May 2021,were retrospectively analyzed.Of the 24 cases,12 were male and 12 female.The male to female ratio was 1∶1.The age range was 21 days to 2 years(median:5 months).The median mass was 5.8 kg.During the PDT,neck ultrasound was used to assess the thyroid position and vascular shape of vessels.After determining the puncture approach and marking the tracheostomy site,the PDT was performed under the guidance of flexible bronchoscopy.Results Before surgery,19 children(79.2%)had received continuous endotracheal intubation mechanical ventilation support,2 children(8.3%)were treated by intermittent endotracheal intubation mechanical ventilation support therapy,and 3 children(12.5%)were supported by the non-invasive ventilator.There were 9 cases(37.5%)of congenital upper respiratory tract malformation,8 cases(33.3%)of bilateral vocal cord paralysis,3 cases(12.5%)of upper respiratory tract neoplastic diseases,2 cases(8.3%)of surgical evacuation difficulties,and 2 cases(8.3%)of neuromuscular disease.All 24 patients successfully completed the operation within 30 min,with bleeding volume less than 5 mL and no intraoperative complications.Conclusions Flexible bronchoscopy and neck ultrasound can assist in the successful PDT in infants,significantly reduce the difficulty and improve the safety of PDT.