纤维支气管镜经皮穿刺气管切开术在神经外科的应用  

Application of percutaneous dilatational tracheotomy under bronchofibroscope in rescue of neurosurgery patients

作　　者：杨鹏举[1] 李静[1] 陈燕[1] 夏莉[1] 程静林[1] 董铁立[1] 刘小军[2] 

机构地区：[1]郑州大学第二附属医院麻醉科,郑州450014 [2]郑州大学第二附属医院ICU,郑州450014

出　　处：《中国实用神经疾病杂志》2011年第8期19-21,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的评价纤维支气管镜(纤支镜)监视下行经皮穿刺气管切开术在神经外科的应用价值。方法回顾性分析40例神经外科危重患者全麻术后纤支镜监视下行经皮穿刺气管切开术,观察其手术时间、切口愈合时间、置管困难原因、术中出血以及进一步处理等情况。结果 40例患者39例PTD手术成功,1例行普通气管切开术,手术平均时间4.5 min,平均切口长1.3 cm。2例导丝置入方向错误,纤支镜及时纠正;2例置管困难,纤支镜证实,1例系气管套管误人气管前间隙,另1例系气管左偏,甲状腺峡部损伤出血,纤支镜15 min检查时软组织深部出血并流入气管内,缝扎止血后改行普通气管切开术。结论纤支镜监视下行经皮穿刺气管切开术在神经外科危重患者中具有迅速、微创的优点,可快速开放气道,降低并发症,具有较高应用价值。Objective To evaluate the clinical value of the percutaneous dilatational tracheotomy（PDT） under bronchofibroscope in the rescue of neurosurgery severe cases.Methods Forty neurosurgery severe patients received PDT were retrospectively analyzed.The operation time,wound healing time,intubating difficulty reason,operating blood loss and how to handle were observed.Results PDT was successfully performed in 40 cases：39 cases adopted PDT,one adopted open tracheotomy.The mean PDT duration was 4.5 minutes and the average incision length was 1.3 cm.The guide wire direction was wrong in two cases and the bronchofibroscope found it and retrieved it promptly.Two cases were found the intubating difficulty,the bronchofibroscope proved that one was intubated in trachea anterior diastema,another was left side bleeding trachea,and was found endotrachea bleeding,finally adopted open tracheostpmy.No severe intraoperative and postoperative complications and no deaths were found.Conclusion PDT under bronchofibroscope possesses high application value especially in neurosurgery severe cases,due to its slight injury,short operation time,high success rate and low complication.

关 键 词：纤维支气管镜 经皮穿刺气管切开术 神经外科 

分 类 号：R653[医药卫生—外科学]