超声引导的经皮扩张气管切开术对其并发症的影响  

Impact of ultrasound guidance on complications of percutaneous dilatational tracheostomy

作　　者：武巧云[1] 丁维强[1] 王云辉[1] 刘丽霞[2] 胡振杰[2] Wu Qiao-yun;Ding Wei-qiang;Wang Yun-hui;Liu Li-xia;Hu zhen-jie(The General Hospital of Fengfeng Group,Handan 056200, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011,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》2019年第9期855-858,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：目的探讨超声引导经皮扩张气管切开术(percutaneous dilatational tracheostomy, PDT)对其并发症的影响,期待减少其并发症。方法回顾分析2015年1月至2018年12月在冀中能源峰峰集团总医院重症医学科行经皮扩张气管切开术的236例患者,其中超声定位引导114例(超声引导组),标准经皮扩张气管切开术(standard percutaneous dilatational tracheostomy, S-PDT)122例(常规组)。两组患者均记录年龄、性别、体质量指数和诊断、入组时的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及序贯器官功能障碍评估(SOFA)评分。比较两组患者在术中及术后出现的并发症。结果常规组发生12例并发症,包括低氧血症1例、出血需干预5例、皮下气肿1例、气管食管瘘1例、假道1例、导丝从口腔穿出2例、导管成角1例;超声引导组出现2例并发症,其中低氧血症1例,出血需干预1例。超声引导组总的并发症明显低于常规组(2/114 vs. 12/122,P=0.009)。结论超声引导的PDT能够明显减少并发症,辅助困难气管切开患者行PDT能提高其成功率。Objective To explore the impact of ultrasound guidance on complications of percutaneous dilatational tracheostomy, and expect to reduce complications of percutaneous dilatational tracheostomy. Methods Between January 2015 and December 2016, 114 consecutive patients who were performed percutaneous dilatational tracheostomy by ultrasound guidance were included in the ultrasound guidance group (US - PDT), 122 consecutive patients who were performed standard percutaneous dilatational tracheostomy ( S - PDT). Data recorded were age, gender, body mass index, diagnosis, acute physiology and chronic health evaluation U ( APACHE II ) score and sequential organ failure assessement( SOFA). Results There were twelve complications in the S - PDT group: hyoxemia (n = 1), bleeding need for intervention ( n = 5 ), pneumoderm ( n = 1 ), esophagotracheal fistula ( n = 1 ), false passage (n = 1), the guide wire coming out of the mouth (n =2), tracheal tube angulation (n = 1). There were two complications in the US - PDT group: hyoxemia ( n = 1 ), bleeding need for intervention (n = 1 ). The total complications in the US - PDT group were significantly lower than those in the S - PDT group (2/114 vs. 12/122, P =0. 009). Conclusion The use of ultrasound guidance during percutaneous dilatational tracheostomy can reduce complications during the procedure.

关 键 词：超声引导 经皮扩张气管切开术(PDT) 并发症 

分 类 号：R459.7[医药卫生—急诊医学]