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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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

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

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