摘要
目的探讨经皮扩张气管切开术(PDT)中应用超声探查及引导穿刺在心脏外科术后患者中的应用效果。方法 2008年7月至2012年8月南京大学医学院附属鼓楼医院心脏术后行气管切开患者共51例,其中瓣膜置换术后20例,主动脉夹层(De Bakey I型)术后17例,冠状动脉旁路移植术11例,先天性心脏病矫治术后3例。根据切开方式不同将患者分为手术切开(ST)组17例,男10例、女7例,年龄(58.0±15.2)岁;纤维支气管镜辅助经皮扩张气管切开(FOB-PDT)组21例,男15例、女6例,年龄(63.5±13.5)岁;超声辅助经皮扩张气管切开(US-PDT)组13例,男7例、女6例,年龄(64.5±10.2)岁。比较3组手术结果及并发症发生情况。结果所有PDT均顺利完成,ST组中手术失败1例。总体出血事件ST组为41.18%、FOB-PDT组9.53%、US-PDT组7.70%(P=0.038),纵隔感染发生率ST组17.65%、FOB-PDT组及US-PDT组均为0%(P=0.046),差异有统计意义。3组气管内导管保留时间、住ICU时间、住院时间、死亡率及术中低氧血症、气胸、皮下气肿等发生率差异无统计学意义,ST组1例后期发生气管狭窄。结论 PDT结合实时超声检查能够提供颈部解剖信息,指导穿刺部位选择,在心脏术后患者中应用能够提高手术安全性,降低操作难度,降低相关并发症发生率。
Objective To evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy （PDT） for patients after cardiac surgery. Methods From July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection （ De Bakey type I） surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy （ST） group, there were 17 patients including 10 males and 7 females with their average age of 58.±15.2 years. In fiberoptic bronchoscope guided PDT （FOB-PDT） group, there were 21 patients including 15 males and 6 females with their average age of 63.5± 13.5 years. In real-time ultrasound-guided PDT （US-PDT） group, there were 13 patients including 7 males and 6 females with their average age of 64.5___ 10.2 years. Surgical outcomes were compared among the 3 groups. Results All PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group （x^2=0.038）. The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group （P=0.046）. There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity （hypoxemia, pneumothorax, subcutaneous emphysema） among the 3groups. One patient in ST group developed late tracheal stenosis. Conclusion Real-time ultrasound can provide infor- mation about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbiditY of PDT of patients after cardiac surgery.
出处
《中国胸心血管外科临床杂志》
CAS
2014年第6期807-812,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
江苏省卫生厅十二五科教兴卫工程医学重点学科(心胸外科学)资助(XK201104)~~
关键词
经皮扩张气管切开
超声
心脏手术
Percutaneous dilatational tracheostomy
Ultrasound
Cardiac surgery
