摘要
目的观察高位经皮气管切开术(PDT)在特殊重症患者中的应用效果。方法回顾性分析2012年1月至2019年7月在南方医科大学附属小榄医院重症医学科(ICU)治疗的78例高位PDT患者的临床资料,分析其实施高位PDT的原因、手术方式、成功率以及安全性。结果在研究期间的近1000例PDT手术重症患者中,发现78例常规位置穿刺存在困难的特殊患者,采用高位(第1~2气管环间隙为穿刺点)PDT手术;全部手术在ICU床旁顺利完成,一针穿刺成功率为92.3%(72/78),无一例中转传统手术;操作时间3~15 min,平均5.5 min;术中出血量2~20 mL,术中未发生大出血、低氧血症、窒息、血管及甲状腺损伤,未发生气管插管意外脱管及气管切开套管置管困难;术后未发生大出血、气胸、切口感染等并发症。结论对于常规PDT手术存在禁忌的一些特殊重症患者,采用高位PDT的成功率及安全性高,具有一定的临床应用价值。
Objective To explore the clinical application of high-position percutaneous dilational tracheostomy(PDT)in special critical patients.Methods In this study,we retrospectively analyze the data of 87 special critical patients with high-position PDT in ICU,Xiaolan Hospital of Southern Medical University during January 2012 to July 2019.The surgical reasons,surgical methods,success rate,and safety of high-position PDT were analyzed.Results During the study,among nearly 1000 patients received PDT surgery,78 patients with difficulties in routine-location puncture received high-position PDT(the 1st to 2nd tracheal annulus space as the puncture point)surgery.All the high-position PDT operations were successfully completed beside the ICU bed,and the success rate of one-needle puncture was 92.3%(72/78),without any transfer to traditional surgery.The operation time was 3 to 15 minutes,with an average operation time of 5.5 minutes.The intraoperative blood loss was 2 mL to 20 mL.No massive hemorrhage,hypoxemia,asphyxia,vascular and thyroid damage occurred during the operation,and no endotracheal intubation and tracheotomy cannula insertion difficulties occurred.No postoperative complications,such as massive hemorrhage,pneumothorax,incision infection occurred.Conclusion For some special critical patients with contraindications in routine PDT operation,high-position PDT yields certain clinical application value with high success rate and safety.
作者
池锐彬
叶铨秋
李超锋
周卉芬
邹启明
古伟光
CHI Rui-bin;YE Quan-qiu;LI Chao-feng;ZHOU Hui-fen;ZHOU Qi-ming;GU Wei-guang(ICU,Xiaolan Hospital of Southern Medical University,Zhongshan 528415,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第17期2246-2248,共3页
Hainan Medical Journal
基金
广东省中山市医学科研项目(编号:2017J186)。
关键词
重症患者
特殊状态
高位
经皮气管切开术
Critical patients
Special state
High-position
Percutaneous dilational tracheostomy
