经支气管镜、超声引导和解剖标志定位经皮扩张气管切开术的比较  

Comparison of percutaneous dilational tracheotomy using bronchoscope,ultrasound guidance and anatomical landmark

作　　者：钱雪琴 朱瑶丽[1] 练荣丽 王轶[1] 覃偲偲 郑昌艳 马蓉 吕柏成 Qian Xueqin;Zhu Yaoli;Lian Rongli;Wang Yi;Qin Sisi;Zheng Changyan;Ma Rong;LüBaicheng(Department of Intensive Care Unit(Surgical ICU),the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院重症医学科(外科ICU),珠海519000 [2]江门鹤山市人民医院重症医学科,鹤山529799

出　　处：《新医学》2024年第1期63-68,共6页Journal of New Medicine

摘　　要：目的比较纤维支气管镜(支气管镜)、超声引导及解剖标志定位三种方式在经皮扩张气管切开术(PDT)中的疗效和安全性。方法选择101例行PDT病例进行回顾性研究,根据手术方式分为3组:支气管镜引导组(39例)、超声引导组(27例)和解剖标志定位组(35例)。收集3组患者人口学资料、一般情况、手术情况、术后并发症和预后情况。结果3组患者的年龄、性别构成、入ICU原因、基础疾病、术前凝血状态比较差异均无统计学意义(P均>0.05)。与其他2组比较,超声引导组术前序贯器官衰竭评分(SOFA)较高、手术时间较短、术中出血量较少(P均<0.05/3)。超声引导组术后PaCO_(2)高于解剖标志定位组(P<0.05/3)。结论PDT中进行实时超声引导可了解颈部解剖结构,对于病情复杂严重患者可减少手术时间、术中出血量,避免过度通气,或许可作为支气管镜引导或解剖标志定位的替代方案。Objective To compare the efficacy and safety of percutaneous dilational tracheostomy(PDT)using fiberoptic bronchoscope,ultrasound guidance and anatomic landmark localization.Methods In this retrospective cohort,101 patients undergoing PDT were enrolled and divided into bronchoscope-guided group(n=39),ultrasound-guided group(n=27),and anatomical landmark localization group(n=35).Demographic data,general condition,surgical condition,postoperative complication and clinical prognosis were collected.Results No statistical significance was found in age,sex,cause of ICU stay,primary disease and preoperative coagulation status(all P>0.05).In the ultrasound-guided group,preoperative Sequential Organ Failure Assessment(SOFA)score was higher,the operation time was shorter and intraoperative blood loss was less compared with those in the other two groups(P<0.05/3).The PaCO_(2)in the anatomical landmark localization group was lower than that in the ultrasound-guided group(P<0.05/3).Conclusions Real-time ultrasound guidance during PDT can be employed to identify the anatomical structures of the neck,which can shorten the operation time,reduce intraoperative bleeding and avoid hyperventilation in patients with severe diseases.Ultrasound-guided PDT may serve as an alternative regimen for PDT using bronchoscope or anatomical landmark localization.

关 键 词：危重症 经皮扩张气管切开术 支气管镜 超声引导 解剖标志定位 

分 类 号：R653[医药卫生—外科学]