超声定位与解剖定位行经皮扩张气管切开术的临床对比研究  

Clinical controlled study of location by traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy

作　　者：武巧云[1] 丁维强[1] 李涛 杨洪颖 张文军[1] 王云辉[1] 刘丽霞[2] Wu Qiao-yun;Ding Wei-qiaag;Li tao;Yang Hong-ying;Zhang Wen-jun;Wang Yun-hui;Liu Li-xia(Critical Care Medicine,the General Hospital of Fengfeng Group,Handan 056200,China)

机构地区：[1]冀中能源峰峰集团总医院重症医学科,河北邯郸056200 [2]河北医科大学第四医院重症医学科,河北石家庄050011

出　　处：《中国急救医学》2018年第9期764-767,共4页Chinese Journal of Critical Care Medicine

基　　金：河北省卫生计生委科学研究课题计划项目（20171516）

摘　　要：目的 探讨经超声定位引导的经皮扩张气管切开术的安全性及有效性。 方法 选取2015-01～2016-01在冀中能源峰峰集团总医院重症医学科（ICU）治疗且行经皮扩张气管切开术的50例患者，按随机数字分组的方法，将患者随机分为超声定位引导经皮扩张气管切开术（USPDT）组及解剖定位经皮扩张气管切开术（ALPDT）组，记录入选患者的年龄、性别、身高、体质量、入组时的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）及序贯器官功能障碍评分（SOFA评分）；同时记录手术时间、1次穿刺成功率、穿刺次数、术中出血量及手术并发症。 结果 50例患者纳入研究，无排除病例。USPDT组患者的1针穿刺成功率（92% vs. 64%）高、穿刺次数［（1.08±0.28）次 vs.（1.56±0.87）次］少、术中出血量［（5.48±4.43）mL vs.（11.20±8.41）mL］及手术时间［（7.12±2.42）min vs.（12.20±5.80）min］少于ALPDT组，差异有统计学意义（P≤0.05）；两组患者低氧血症、皮下气肿、气管食管瘘、假道、术后出血发生率比较差异无统计学意义（P〉0.05）。 结论 超声定位引导明显提高1次穿刺成功率和穿刺准确性，减少术中出血量。超声引导的经皮气管切开术值得临床推广应用。Objective To evaluate the procedural safety and efficacy of ultrasound guidance during percutaneous dilatational tracheostomy （PDT）. Methods Between January 2015 and December 2016, 50 consecutive patients were included in the study, the patients were divided randomly into two groups. In group USPDT （ n = 25 ）, PDT was performed by using ultrasound guidance. In group ALPDT （ n = 25）, PDT was performed by using traditional anatomical landmarks. The parameters of vital signs, age, gender, height, weight, the Acute Physiology and Chronic Health Evaluation Ⅱ score （APACHE Ⅱ）, the Sequential Organ Failure Assessment （SOFA） were recorded at the time of enrollment. The procedure time, first - pass success rate, number of puncture, amount of bleeding and complications were recorded for all the patients. Results There were no excluded cases. Compared with the ALPDT group, first - pass success rate （92% vs. 64% ） was higher, the number of puncture （ 1.08 ± 0.28 vs.1.56 ±0.87） was lower, the procedure time[ （7.12 ±2.42）min vs. （ 12.20 ±5.80） mini and amount of bleeding [ （5.48± 4.43 ） mL vs. （ 11.20 ± 8.41 ） mL ] during operation in USPDT group were less （P 〈0.05 ）. The decrease in procedural complications was not statistically significant. Conclusion Ultrasound guidance significantly improves the rate of first - pass puncture and puncture accuracy. Less bleeding during operation is observed. These results support wider general use of ultrasound guidance as an additional tool to improve PDT.

关 键 词：超声引导 经皮扩张气管切开术 并发症 

分 类 号：R655.3[医药卫生—外科学]