经支气管镜、超声引导和解剖标志定位经皮扩张气管切开术的比较
Comparison of percutaneous dilational tracheotomy using bronchoscope,ultrasound guidance and anatomical landmark
钱雪琴 1朱瑶丽 1练荣丽 1王轶 1覃偲偲 1郑昌艳 1马蓉 1吕柏成2
作者信息
- 1. 519000 珠海,中山大学附属第五医院重症医学科(外科ICU)
- 2. 529799 鹤山,江门鹤山市人民医院重症医学科
- 折叠
摘要
目的 比较纤维支气管镜(支气管镜)、超声引导及解剖标志定位三种方式在经皮扩张气管切开术(PDT)中的疗效和安全性.方法 选择101例行PDT病例进行回顾性研究,根据手术方式分为3组:支气管镜引导组(39例)、超声引导组(27例)和解剖标志定位组(35例).收集3组患者人口学资料、一般情况、手术情况、术后并发症和预后情况.结果 3组患者的年龄、性别构成、入ICU原因、基础疾病、术前凝血状态比较差异均无统计学意义(P均＞0.05).与其他2组比较,超声引导组术前序贯器官衰竭评分(SOFA)较高、手术时间较短、术中出血量较少(P均＜0.05/3).超声引导组术后PaCO2高于解剖标志定位组(P＜0.05/3).结论 PDT中进行实时超声引导可了解颈部解剖结构,对于病情复杂严重患者可减少手术时间、术中出血量,避免过度通气,或许可作为支气管镜引导或解剖标志定位的替代方案.
Abstract
Objective To compare the efficacy and safety of percutaneous dilational tracheostomy(PDT)using fiberoptic bronchoscope,ultrasound guidance and anatomic landmark localization.Methods In this retrospective cohort,101 patients undergoing PDT were enrolled and divided into bronchoscope-guided group(n=39),ultrasound-guided group(n=27),and anatomical landmark localization group(n=35).Demographic data,general condition,surgical condition,postoperative complication and clinical prognosis were collected.Results No statistical significance was found in age,sex,cause of ICU stay,primary disease and preoperative coagulation status(all P＞0.05).In the ultrasound-guided group,preoperative Sequential Organ Failure Assessment(SOFA)score was higher,the operation time was shorter and intraoperative blood loss was less compared with those in the other two groups(P＜0.05/3).The PaCO2 in the anatomical landmark localization group was lower than that in the ultrasound-guided group(P＜0.05/3).Conclusions Real-time ultrasound guidance during PDT can be employed to identify the anatomical structures of the neck,which can shorten the operation time,reduce intraoperative bleeding and avoid hyperventilation in patients with severe diseases.Ultrasound-guided PDT may serve as an alternative regimen for PDT using bronchoscope or anatomical landmark localization.
关键词
危重症/经皮扩张气管切开术/支气管镜/超声引导/解剖标志定位Key words
Critical illness/Percutaneous dilational tracheostomy/Bronchoscope/Ultrasound guidance/Anatomical landmark localization引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据