光索辅助经皮扩张气管切开术在神经重症患者中的应用  

Percutaneous dilatational tracheostomy assisted by flexible lightwand in patients with severe neurological disease

作　　者：杨林 秦逊 向琰 黄国浩 张晓青 裴玉春 杨伟 李瑶 吕胜青 YANG Lin;QIN Xun;XIANG Yan;HUANG Guo-hao;ZHANG Xiao-qing;PEI Yu-chun;YANG Wei;LI Yao;LYU Sheng-qing(Department of Neurosurgery, Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]中国人民解放军陆军军医大学第二附属医院神经外科,重庆400037

出　　处：《局解手术学杂志》2020年第5期368-373,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：中国人民解放军陆军军医大学临床医学科研人才培养计划(2018XLC3030)。

摘　　要：目的探讨光索辅助经皮扩张气管切开术(FL-PDT)对经气管插管机械通气的神经重症患者的应用效果,评估FL-PDT穿刺的准确性及安全性。方法选取2018年4月至2019年12月我院神经外科收治的需行气管切开的52例经气管插管机械通气患者为研究对象,按照随机数表法分为FL-PDT组及PDT组,每组26例。FL-PDT组患者采用光索辅助经皮扩张气管切开术,PDT组采用常规经皮扩张气管切开术。比较2组患者术中情况及术后并发症发生情况。结果在首次穿刺成功率、意外拔管率、气管插管被刺率及手术时间方面,2组患者比较差异有统计学意义(P<0.05);2组患者术后出血及皮下气肿发生率比较,差异无统计学意义(P>0.05),但需处理的出血情况比较,差异有统计学意义(P<0.05)。结论FL-PDT具有定位准确、首次穿刺成功率高、手术时间短、术中安全性高、术后出血少等优点,具有较高的临床应用价值。Objective To analyze the effect of flexible lightwand assisted percutaneous dilatational tracheostomy(FL-PDT)on patients with severe neurological disease who need sustained endotracheal intubation and mechanical ventilation,and the puncture accuracy and safety of FL-PDT are assessed.Methods From April 2018 to December 2019,a total of 52 patients with severe neurological disease who need sustained endotracheal intubation and mechanical ventilation in neurosurgery department of our hospital were divided into FL-PDT group and percutaneous dilational tracheostomy(PDT)group according to random number table,with 26 cases in each group.Patients in FL-PDT group were treated with percutaneous dilatational tracheostomy assisted by flexible lightwand,and patients in PDT group were treated with conventional percutaneous dilatational tracheostomy.The intraoperative conditions and postoperative complications of the two groups were compared.Results There were significant differences between the two groups in the successful rate of first puncture,the rate of inadvertent endotracheal intubation extubated and punctured,the operation time(P<0.05).There was no significant difference in the incidence of postoperative hemorrhage and subcutaneous emphysema between the two groups(P>0.05).However,the difference in hemorrhage needed for treatment was significant between the two groups(P<0.05).Conclusion FL-PDT has high clinical application value with advantages of accurate location,high rate of successful puncture,short operation time,high safety and less postoperative hemorrhage for patients of severe neurological disease who need sustained endotracheal intubation and mechanical ventilation.

关 键 词：光索 经皮扩张气管切开术 气管插管 机械通气 神经重症 

分 类 号：R459.7[医药卫生—急诊医学]