改良纤维支气管镜下经皮旋转扩张气管切开术在ICU危重患者的应用：附4种方法的对比研究  

Application of modified percutaneous rotating dilative tracheostomy with fiberoptic bronchoscope in critical patients of ICU： a control study for four kinds of tracheostomy

作　　者：张虹[1] 徐艳敏[2] 李海红[1] 张瑶[1] 崔轮盟 赵琳琳[1] 姚庆欢 谢凤杰[1] 

机构地区：[1]牡丹江医学院红旗医院重症医学科,黑龙江牡丹江157011 [2]牡丹江医学院红旗医院耳鼻喉科,黑龙江牡丹江157011

出　　处：《中华危重病急救医学》2017年第1期61-65,共5页Chinese Critical Care Medicine

基　　金：黑龙江省医药卫生科研课题（2014-194）

摘　　要：目的观察改良纤维支气管镜（纤支镜）下经皮旋转扩张气管切开术（MPRDT—FOB）在重症加强治疗病房（ICU）的临床应用效果，并与传统经皮扩张气管切开术（PDT）、改良经皮扩张气管切开术（MPDT）和纤支镜下经皮扩张气管切开术（PDT—FOB）进行比较。方法采用前瞻性研究方法，选择2011年2月至2016年11月牡丹江医学院红旗医院ICU收治的240例需要气管切开的危重患者，按随机数字表法分为4组，每组60例。PDT组采用传统Portex方法进行气管切开；MPDT组先按照PDT方法操作，在穿刺、扩张等操作过程中气管导管始终保持原位，当气管扩张完毕后再将气管导管后退至穿刺部位以上距门齿约16—18cm处；PDT—FOB组在纤支镜直视下完成PDT操作；MPRDT-FOB组结合PDT—FOB和MPDT的方法，于纤支镜下先扩张切口，再换用旋转扩张器扩张至气管前壁。比较4种方法的手术操作时间、切口长度、术中出血量、一次性成功率，以及围手术期和远期并发症的发生情况。结果与PDT和PDT—FOB比较，MPDT和MPRDT—FOB的手术时间明显缩短（min：6．57±3．59、7．09±2．55比12．20±2．01、10．13±2．37），切口明显减小（cm：1．20±1．00、1．20±0．90比1．59±1．18、1．32±1．24），术中出血量明显减少（mL：6．81±2．19、6．60±1．99比10．28±3．68、8．11±2．96，均P〈0．05）；尽管MPDT与MPRDT—FOB组间差异无统计学意义，但MPRDT—FOB在数值上均优于MPDT，且一次性成功率明显高于MPDT[100．00％（60／60）比91．67％（55，60），P〈0．05]。4种方法均出现了术后出血、心律失常、支气管痉挛等围手术期并发症，但MPRDT-FOB的发生率较PDT、MPDT和PDT-FOB低；PDT和MPDT以气管后壁损伤或穿孔、误吸、插管困难等并发症较多见，而PDT—FOB和MPRDT—FOB无这些并发症发生。PDT远期并发症以气管食管瘘最多见，且发生率显著高�Objective To investigate the clinical application of modified percutaneous rotating dilative tracheostomy with fiberoptic bronchoscope （MPRDT-FOB） in critical patients of intensive care unit （ICU） by comparing it with percutaneous dilative tracheostomy （PDT）, modified percutaneous dilative tracheostomy （MPDT）, and percutaneous dilative tracheostomy with fiberoptic bronchoscope （PDT-FOB）. Methods A prospective control study was conducted. 240 critical patients underwent tracheotomy admitted to ICU of Mudanjiang Medical University Hongqi Hospital from February 2011 to November 2016 were enrolled, and they were randomly divided into four groups with 60 patients in each group. The patients in PDT group received traditional Portex method for tracheotomy. The patients in MPDT group received PDT method first, in the process of puncture and expansion, the trachea catheter was always retained in situ, and then retreated to the puncture site about 16-18 cm from incisor after withdrawal of the dilator.The patients in PDT-FOB group received PDT with fiberoptic bronchoscope. The patients in MPRDT-FOB group received PDT-FOB combined with MPDT, in bronchoscope expansion incision, and was replaced with rotary expander to the anterior wall of the trachea. The duration of operation, the size of incision, blood loss during operation, and the rate of disposable success, as well as the incidence of perioperative and long-term complications among four kinds of tracheostomy were compared. Results Compared with PDT and PDT-FOB, the duration of operation in MPDT and MPRDT-FOB was significantly shortened （minutes： 6.57±3.59, 7.09±2.55 vs. 12.20±2.01, 10.13±2.37）, the size of incision was significantly diminished （cm： 1.20 ± 1.00, 1.20 ± 0.90 vs. 1.59 ± 1.18, 1.32± 1.24）, and the amount of blood loss during operation was significantly decreased （mL： 6.81 ± 2.19, 6.60 ± 1.99 vs. 10.28 ± 3.68, 8.11 ± 2.96, all P 〈 0.05）. There were no significant differences in above parameters between MPDT

关 键 词：改良纤维支气管镜下经皮旋转扩张气管切开术 改良经皮扩张气管切开术 纤维支气管 镜下经皮扩张气管切开术 经皮扩张气管切开术 重症加强治疗病房 危重患者 

分 类 号：R655[医药卫生—外科学]