超声引导定位在重症机械通气患者经皮扩张性气管切开术中应用效果

Effect of ultrasound-guided localization in critically ill mechanically ventilated patients treated with percutaneous dilational tracheostomy

目的探讨超声引导定位在重症机械通气患者经皮扩张性气管切开术(PDT)中的应用效果。方法选取2021年1月至2023年12月深圳市光明区人民医院急诊及重症监护病房内80例行PDT的机械通气患者,根据手术定位方式的不同随机分为超声定位组和传统组,每组40例。超声定位组采用实时超声引导定位,传统组采用传统解剖标记定位。比较两种定位方式下PDT耗时、首针穿刺成功例数、穿刺成功尝试的次数、中线偏差度、中线偏斜例数,以及并发症的发生情况。结果超声定位组中线偏差度少于传统组,穿刺点发生中线偏斜的发生率低于传统组,穿刺成功尝试的次数少于传统组,首针穿刺成功率高于传统组,差异均有统计学意义(P<0.05);两组患者PDT手术耗时比较,差异无统计学意义(P>0.05)。超声定位组并发症发生率[2.5%(1/40)]低于传统组发生率[37.5%(15/40)],差异有统计学意义(P<0.05)。结论与传统解剖标记定位相比,重症机械通气患者采用超声引导定位下行PDT并未明显增加耗时,且首针穿刺成功率高,穿刺成功尝试的次数少、穿刺点离中线偏差度少、并发症发生率更低。

Objective To explore the Effect of ultrasound-guided localization in critically ill mechanically ventilated patients treated with percutaneous dilational tracheostomy.Methods A total of 80 patients with mechanical ventilation who underwent tracheotomy in the department of acute and critical care medicine of our hospital from January 2021 to December 2023 were selected.According to the inclusion and exclusion criteria,80 patients were finally included and randomly divided into the ultrasonic positioning group and the conventional group according to the positioning methods.The ultrasonic positioning group used real-time ultrasound guided positioning,and the conventional group used traditional anatomical markers positioning.The deviation degree,the duration of the procedure,the number of successful puncture attempts,the success rate of first needle puncture and the occurrence of complications were compared between the two positioning methods.Results The deviation of puncture point from midline in the ultrasonic positioning group was significantly less than that in the conventional group(P<0.05),and the incidence of deviation from midline in the ultrasonic positioning group was lower than that in the conventional group(P<0.05).The first needle passing rate in the ultrasonic positioning group was significantly higher than that in the conventional group(P<0.05).The duration of the procedure in the ultrasonic positioning group was slightly higher than that in the conventional group,but there was no statistical difference(P>0.05).The incidence of surgical bleeding and total complications in the ultrasonic positioning group were significantly lower than those in the conventional group(P<0.05).Conclusion Compared with traditional anatomical marker positioning,PDT in patients with severe mechanical ventilation guided by ultrasound did not significantly increase the time,and the success rate of first needle puncture was high,the number of successful puncture attempts was less,the puncture point was less deviated from the midline,and the incidence of complications was lower,which was worthy of clinical promotion.