超声引导与纤维支气管镜引导下气管切开的对照研究

目的 探讨超声引导下经皮扩张气管切开在机械通气患者中的安全性及有效性.方法 选择2014年5月至2017年4月ICU接受机械通气的危重症患者44例.按随机数字表法分为2组,超声引导下经皮扩张气管切开组和纤维支气管镜下经皮扩张气管切开组.观察两组患者气管切开过程相关指标、气管切开并发症及相关临床预后.结果 两组患者在穿刺次数及术中出血情况比较差异有统计学意义(P<0.05),超声引导下经皮扩张气管切开组较纤维支气管镜下经皮扩张气管切开组穿刺次数减少、出血发生风险降低.而在操作难易程度、穿刺时间、气囊刺破情况比较差异无统计学意义(P>0.05).两组患者在术后肺不张发生率、持续性急性缺氧发生率比较差异有统计学意义(P<0.05),超声引导下经皮扩张气管切开组较纤维支气管镜下经皮扩张气管切开组肺不张、短暂性急性缺氧发生率更高.而两组患者在其它并发症(短暂性低血压、气管切口感染)及临床预后指标(气管切开后脱机时间、ICU住院时间、ICU死亡率)比较差异无统计血意义(P>0.05).两种经皮扩张气管切开方式术后患者30d生存曲线的比较差异无统计学意义(P=0.650).结论 超声引导下经皮扩张气管切开减少穿刺过程中出血风险及提高穿刺成功率,但可能增加持续性低氧血症及肺不张的发生.超声引导不能完全取代纤维支气管镜常规应用于经皮气管切开.

Objective To evaluate the safety and efficacy of ultrasound-guided percutaneous dilational tracheostomy in patients undergoing mechanical ventilation. Methods From May 2014 to April 2017,44 newly admitted critically ill patients with ICU who were admitted to the hospital of traditional Chinese and Western medicine in Taizhou and received mechanical ventilation were selected. According to the random number table method, the patients were divided into 2 groups,the group was treated with percutaneous dilational tracheostomy under the fiberoptic bronchoscope and the ultrasound guided percutaneous dilational tracheostomy group. The related indexes,complications and clinical prognosis of tracheotomy in two groups were observed. Results Two groups of patients in the number of puncture and bleeding during the operation was statistically significant difference(P<0.05), ultrasound guided percutaneous dilational tracheostomy group compared with fiberoptic bronchoscopy and percutaneous dilatation tracheotomy group puncture frequency was reduced,and the risk of bleeding was reduced. However,there was no significant difference in the degree of operation difficulty, puncture time and air sac puncture(P>0.05). There was statistical significance in two groups of patients with postoperative atelectasis,incidence of acute hypoxia transient rate(P<0.05). Compared with fiberoptic bronchoscopy and percutaneous dilatation tracheotomy group atelectasis,transient acute hypoxia in ultrasound guided percutaneous dilational tracheostomy group was much higher. The two groups of patients with other complications (transient hypotension,wound infection)and clinical prognosis indexes(gas cut after weaning time,hospitalization time and mortality ICU ICU)had no statistical significant difference between blood(P>0.05). There was no significant difference between the 30 d survival curves of the patients treated with percutaneous dilational tracheostomy(P=0.650). Conclusion Ultrasound guided percutaneous dilatational tracheostomy increases the incidence of transient hypoxemia and atelectasis,but reduces the risk of bleeding during puncture and increases the success rate of puncture.