床旁多普勒超声引导下经皮扩张钳扩张气管切开术在神经重症监护病房重症患者中的应用分析

Application of bedside Doppler ultrasound-guided percutaneous dilatational tracheostomy for critically ill patients in neurological intensive care unit

目的探究床旁多普勒超声引导下经皮扩张钳扩张气管切开术(PDT)在神经重症监护病房(NCU)重症患者中的应用。方法选择黄河三门峡医院NCU收治的68例患者,其中男性47例,女性21例,年龄40~65岁,平均年龄53.04岁;身体质量指数(BMI)20~27 kg/m^(2),平均BMI 23.79 kg/m^(2);有吸烟史41例,饮酒史44例;重症颅脑损伤13例,高血压脑出血20例,蛛网膜下腔出血12例,其他23例。采用随机数字表法将68例患者分为2组,其中对照组(n=34)行PDT治疗,试验组(n=34)采用床旁多普勒超声引导下PDT治疗。比较两组手术情况、穿刺及气管插管情况及并发症。结果试验组出血量、手术时间少于对照组[(2.53±0.21)mL vs(3.29±0.46)mL,(10.25±2.06)min vs(11.31±2.18)min](P<0.05)。试验组一针穿刺及置管成功率均高于对照组(88.24%vs 64.71%,100.00%vs 88.24%)(P<0.05);其余指标比较,差异无统计学意义(P>0.05)。两组术后并发症发生率比较,试验组低于对照组(5.88%vs 29.41%)(P<0.05)。结论床旁多普勒超声引导下PDT可显著缩短NCU重症患者手术时间、减少出血量,提升一针穿刺成功率与置管成功率,同时降低术后并发症发生风险,值得临床推广。

Objective To explore the application of bedside Doppler ultrasound-guided percutaneous dilatational tracheostomy(PDT)for critically ill patients in neurological intensive care unit(NCU).Methods A total of 68 patients admitted to NCU were enrolled,which included 47 males and 21 females,aged 40-65 years old with mean age of 53.04 years old;body mass index(BMI)was 20-27 kg/m^(2) with mean BMI of 23.79 kg/m^(2);41 cases of smoking history and 44 of drinking history.There were 13 cases of severe craniocerebral injury,20 of hypertensive cerebral hemorrhage,12 of subarachnoid hemorrhage and 23 of other diseases.All of them were divided into 2 groups by random number table method,the control group(n=34)was treated with PDT,and experimental group(n=34)was treated with bedside Doppler ultrasound-guided PDT.The operation,puncture,tracheal intubation and complications were compared between 2 groups.Results The bleeding volume and operation time in experimental group were less than those in control group[(2.53±0.21)mL vs(3.29±0.46)mL,(10.25±2.06)minutes vs(11.31±2.18)minutes](P<0.05).The success rate of the first puncture and catheterization in experimental group were higher than those in control group(88.24%vs 64.71%,100.00%vs 88.24%)(P<0.05).There was no statistically significant difference in the other indicators(P>0.05).The incidence of postoperative complications in experimental group was lower than that in control group(5.88%vs 29.41%)(P<0.05).Conclusion It is demonstrated that the bedside Doppler ultrasound-guided PDT could significantly shorten operation time and bleeding volume,improve success rate of the first puncture and catheterization,and reduce risk of postoperative complications for critically ill patients in NCU,which is worthy of clinical promotion.