床旁超声引导下经皮气管切开术与传统气管切开术对ICU重症患者气管环周围组织损伤情况的影响比较

doi:10.3969/j.issn.1006-6233.2023.11.026

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摘要 目的: 探究床旁超声引导下经皮气管切开术(percutaneous dilational tracheostomy,PDT)与传统气管切开术(surgery tracheostomy,ST)对ICU重症患者气管环周围组织损伤情况的影响。方法: 回顾性分析2019年1月至2022年8月于我院就诊的采用床旁超声引导下PDT进行治疗的48例ICU重症患者临床资料,纳入超声组;回顾性分析同期于我院就诊的采用ST进行治疗的46例ICU重症患者临床资料,纳入传统组。比较两组患者围术期指标(手术时长、术中出血量、机械通气时间)、切口损伤情况(切口长度、一次性置管成功率、气囊未破裂率),比较两组患者术前及术后1周炎症因子水平[血沉(ESR)、C反应蛋白(CRP)、降钙素原(PCT)],并统计两组患者术后并发症(气胸、喉返神经损伤、食管损伤、气管瘘、肺部感染、气管后壁损伤)发生情况。结果: 超声组患者手术时长、术中出血量均明显低于传统组(P<0.05);超声组与传统组患者机械通气时间比较差异无明显差异(P>0.05);超声组患者切口长度明显短于传统组(P<0.05);超声组患者一次性置管成功率、气囊未破裂率与传统组比较差异无统计学意义(P>0.05);术后1周,两组患者ESR、CRP、PCT水平明显低于术前,且超声组明显低于传统组(P<0.05);超声组术后并发症总发生率明显低于传统组(P<0.05)。结论: 床旁超声引导下PDT相较于ST,具有手术迅速、对患者创伤较小,可有效降低因手术创伤对患者造成的炎症反应水平,且对患者气管环周围组织损伤较小,患者术后并发症发生率较低,安全性较好。

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关键词 ：重症患者, 床旁超声, 经皮气管切开术, 传统气管切开术, 气管环, 组织损伤

Abstract：Objective: To explore the effects of bedside ultrasound-guided percutaneous dilational tracheotomy (PDT) and surgery tracheostomy (ST) on tissue damage around the tracheal ring in critically ill patients in ICU. Methods: Clinical data from 48 critically ill ICU patients who underwent bedside ultrasound-guided PDT between January 2019 and August 2022 were retrospectively analyzed and categorized as the ultrasound group.Additionally,data from 46 ICU patients who received ST during the same period were analyzed and categorized as the traditional group.We compared perioperative factors (surgery duration,intraoperative blood loss,mechanical ventilation time),incision-related variables (incision length,one-time catheterization success rate,balloon rupture rate),and levels of inflammatory markers (erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),procalcitonin (PCT)) before and one week after the surgery.Postoperative complications (pneumothorax,recurrent laryngeal nerve injury,esophageal injury,tracheal fistula,pulmonary infection,posterior tracheal wall injury) were assessed in both groups. Results: The ultrasound group exhibited significantly shorter surgery duration and less intraoperative blood loss compared to the traditional group (P<0.05).There was no significant difference in mechanical ventilation time between the two groups (P>0.05).Patients in the ultrasound group had significantly shorter incision lengths compared to the traditional group (P<0.05).The one-time catheterization success rate and balloon rupture rate showed no statistically significant differences between the two groups (P>0.05).One week after surgery,both groups showed significantly lower levels of ESR,CRP,and PCT compared to before the surgery,with the ultrasound group displaying significantly lower levels than the traditional group (P<0.05).The total incidence of postoperative complications was significantly lower in the ultrasound group compared to the traditional group (P<0.05). Conclusion: Bedside ultrasound-guided PDT,compared to ST,offers advantages such as shorter surgery duration,reduced patient trauma,decreased postoperative complications,and lower inflammatory response levels.This method provides better patient safety and preservation of peri-tracheal tissue integrity.

Key words： Critically ill patients Bedside ultrasound Percutaneous dilational tracheostomy Surgery tracheostomy Tracheal ring Tissue damage

基金资助:安徽省重点研究和开发计划项目,(编号:1804h08020267)

引用本文:

汪少卫, 刘登东, 凌斌, 陈波, 胡家彭. 床旁超声引导下经皮气管切开术与传统气管切开术对ICU重症患者气管环周围组织损伤情况的影响比较[J]. 河北医学, 2023, 29(11): 1891-1896.
WANG Shaowei, LIU Dengdong, LING Bin, et al. Comparison of the Impact of Bedside Ultrasound-Guided Percutaneous Dilational Tracheostomy and Surgical Tracheostomy on Peri-Tracheal Tissue Damage in Critically Ill ICU Patients. HeBei Med, 2023, 29(11): 1891-1896.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.11.026 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I11/1891

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