床旁超声指导下在重症患者中的经皮扩张气管切开术  

Percutaneous dilational tracheostomy (PDT) guided by Beside Ultrasound in intensive care unit --A retrospective cohort study of the real world

作　　者：谌宏军[1] 刘丽丽[2] 张伟[1] CHEN Hongjun;LIU Lili;ZHANG Wei(Department of Intensive Care Unit,Affiliated hospital of Zunyi medical college,Zunyi,Guizhou 563003,China;Department of Cerebral Vascular,Affiliated hospital of Zunyi medical college,Zunyi,Guizhou 563003,China)

机构地区：[1]遵义医学院附属医院重症医学科,贵州遵义563003 [2]遵义医学院附属医院脑血管外科,贵州遵义563003

出　　处：《重庆医学》2019年第A01期78-81,共4页Chongqing medicine

摘　　要：目的评估在重症医学科行床旁超声指导下经皮扩张气管切开术(PDT)的安全性和有效性。方法单中心、真实世界的回顾性队列研究从2014年3月至2016年12月在床旁行经皮扩张气管切开术的患者,在行PDT术前先行床旁B超辅助定位(A组)。同期纳入单纯盲法行PDT病例(B组),收集入选患者电子病历记录、人口学资料、整个手术和并发症。结果共搜集病例201例,资料详细记录者190例。其中A组132例(69.47%),B组58例(30.53%)。年龄14~103岁。36~59岁患者居多,A组(57.58%)和B组(55.17%),两组差异无统计学意义(P=0.758)。手术时间A组(15+10)min,B组(10+5)min,差异有统计学意义(Z=-4.547,P<0.05)。出血量A组(10+2)mL和B组(3+2)mL,差异具有统计学意义(Z=-4.214,P<0.05)。A组中转外科开放手术(0.76%)和术中心跳骤停(0.76%)各1例,B组无上述并发症。总体并发症发生率较高,约49.47%(94/190),A组53.79%(71/132),B组39.66%(23/58),多数是极轻微的次要并发症,对患者预后无不良影响,无绝对风险差异95%CI(62.9%~76.1%)。两组均无死亡并发症。结论床旁超声辅助行PDT是一项可行、安全和有效的方法,对降低并发症是有益的,值得临床推广应用。Objective To evaluate the safety and efficacy of percutaneous dilational tracheostomy (PDT) guided by Beside Ultrasound in intensive care unit. Methods We retrospectively analyzed patients who underwent PTD at the bedside between March 2014 and December 2016.These patients (group A) received PTD in the traditional method,the other patients (group B) underwent bedside ultrasound localization before PDT surgery.All demographic data,surgical procedures and complications were obtained from electronic medical record management system. Results A total of 201 cases were collected,190 of which were included in the statistical analysis.There were 132 cases in group A (69.47%) and 58 cases in group B (30.53%).The youngest is 14 years old and the oldest is 103 in these patients.The majority of patients in both group are 36-59 years old.There was no statistical difference in the age between the two groups ( P =0.758).The operation time of group A was longer than that of group B(12 min vs 10 min, Z =-4.547, P <0.05).The amount of bleeding in group A was more than that in group B(5mL vs 2mL, Z =-4.214, P <0.05).In group A,1 patients underwent open surgery,and 1 patients had cardiac arrest.While,there was no patient underdoing open surgery or having cardiac arrest in group B.The total complication rate in group A was higher than that in group B ( 53.79 %(71/132)vs 39.66%(23/58), P <0.05).All complications had no adverse effect on the prognosis of the patients.No deaths occurred in the two groups. Conclusion PDT guided by Beside Ultrasound in intensive care unit is a feasible,safe and effective method.It can reduce complications and is worthy of clinical promotion.

关 键 词：经皮扩张气管切开术 床旁B超 危重病 

分 类 号：R655.3[医药卫生—外科学]