床旁纤维支气管镜直视下经皮扩张气管切开术在高龄危重症患者中的应用  

Clinical application of bedside fiberoptic bronchoscopy-assisted percutaneous dilatational tracheostomy in critical elderly patients

作　　者：韩晓博 马秋霞 费月海 刘于红 

机构地区：[1]海军总医院干部病房综合内科重症监护病房,北京100048 [2]海军疾病预防控制中心

出　　处：《中华保健医学杂志》2016年第2期138-141,共4页Chinese Journal of Health Care and Medicine

摘　　要：目的探讨在高龄危重症患者中应用纤维支气管镜引导下经皮扩张气管切开术的安全性及疗效。方法回顾性分析2010年10月-2014年10月在海军总医院重症监护室完成床旁气管切开术的高龄（年龄≥80岁）危重症患者62例,其中床旁常规外科气管切开术组（CST组）28例,床旁纤维支气管镜直视下经皮扩张气管切开术组（PDT组）34例。收集患者气管切开前的一般资料、呼吸机支持条件、凝血状况,以及手术流程、术中氧饱和度情况等。比较两组患者围手术期各阶段所需时间、术中出血量、最低氧饱和度以及术中、术后并发症发生情况。结果所有患者均置管顺利,PDT组在围手术期各阶段所用时间、术中出血、术后并发症及术后ICU滞留时间均较CST组明显减少（P〈0.05）。结论纤维支气管镜引导下经皮扩张气管切开术与传统外科气管切开术比较,具有创伤小、用时短、并发症少等特点,在高龄重症患者中安全可行。Objective To evaluate the clinical efficacy and safety of bedside fiberoptic bronchoscopy-assisted percutaneous dilatational tracheostomy in critical elderly patients. Methods The data of 62 cases over 80 years old in our hospital from October2010 to October 2014 who needed tracheotomy in intensive care units was studied retrospectively. Twenty eight cases underwent conventional surgical tracheostomy（CST） and 34 underwent fibrobronchoscope-assisted percutaneous dilational tracheostomy（PDT）.Their general information before surgery and the operation admission time, operation time, bleeding, the lowest oxygen saturation,postoperative complications in perioperative period were summarized and analyzed. Results The cases underwent PDT had shorter admission time, shorter operation time, less bleeding, fewer complications and shorter lengths of stay post tracheostomy compared with the cases underwent CST. Conclusion The fiberoptic bronchoscopy-assisted percutaneous dilatational tracheostomy helps to reduce appointment time, operation time and length of stay post tracheostomy significantly. It also has the features of less injury, less bleeding and complications. PDT can be used safely and effectively in critical elderly patients.

关 键 词：经皮扩张气管切开 纤维支气管镜 高龄 危重症 

分 类 号：R653[医药卫生—外科学]