床旁多普勒超声引导下经皮气管切开术在重症脑出血患者中的应用

Application of bedside Doppler ultrasoundguided percutaneous dilatational tracheostomy in patients with sever cerebral hemorrhage

摘要:

目的探讨床旁多普勒超声引导下经皮气管切开术（PDT）在重症脑出血患者中的应用价值。方法选取2014年1月—2019年4月南方医科大学附属小榄医院重症医学科监护治疗的重症脑出血患者126例，在ICU床旁采用超声引导下行PDT。术前采用超声进行检查，明确气管位置、周围组织及血管情况，确定穿刺部位及深度，指导术前气管导管退管。术中实时超声引导，确保手术安全。术后超声确认气管切开套管位置，筛查排除气胸等相关并发症。观察操作时间（从皮肤穿刺到成功置入气管套管时间）、一针穿刺成功率、置管成功率、气管插管意外脱管率；观察术中及术后并发症：出血量、血管/甲状腺损伤、气管后壁损伤、皮下气肿、气胸、低氧血症发生率等。结果126例患者手术均一次操作成功，一针穿刺成功率及置管成功率均为100%，未发生气管插管意外脱管。操作时间5~12 min，平均操作时间7.5 min。术中及术后未发生难以控制的大出血、严重低氧血症、血管/甲状腺损伤、气管后壁损伤、皮下气肿及气胸等并发症。结论对重症脑出血患者行床旁实时超声引导下行PDT，提高了手术的可视性、操作性和安全性，提高PDT成功率，降低相关并发症，具有良好的临床价值。

关键词:床旁超声|经皮气管切开术|重症脑出血|可视化|手术安全

Abstract:

ObjectiveTo explore the application value of bedside Doppler ultrasound guided percutaneous dilatational tracheostomy (PDT) in critical patients with cerebral hemorrhage.MethodsIt was analyzed for clinical data of 126 critical patients with cerebral hemorrhage whom were admitted in Department of Critical Care Medicine，Xiaolan Hospital of Southern Medical University from Jane 2014 to April 2019. All patients were conducted with bedside ultrasound guided PDT. Ultrasound was performed before operation to determine the position of the trachea, surrounding tissues and blood vessels, in order to determine the location and depth of the puncture, and guide the preoperative evacuation of the tracheal tube. Intraoperative ultrasound guidance ensured the operation safely in surgery. Postoperative ultrasound were done to confirm the position of the tracheotomy sleeve and screened for the related complications such as pneumothorax etc. The operation time (from skin puncture to successful placement of tracheotomy sleeve), a needle success rate, success rate of catheterization, accidental detached rate of endotracheal tube. Intraoperative and postoperative complications were observed such as incidence of bleeding volume, blood vascular /thyroid injury, posterior tracheal wall injury, subcutaneous emphysema, pneumothorax and hypoxemia, etc.ResultsAll the 126 patients underwent a successful operation. The success rate of oneneedle puncture and catheterization was 100%. No detach accidental of endotracheal tube. The operation time was 5~12 min, and the average operation time 7.5 min. No complications occurred, including uncontrollable major hemorrhage, severe hypoxemia, vascular/thyroid injury, posterior tracheal wall injury, subcutaneous emphysema, and pneumothorax during operation or after operation.ConclusionApplying realtime ultrasoundguided PDT could improve the visibility, operability and safety of the operation, increase the success rate of PDT, and reduce the related complications, which has good clinical value in patients with sever cerebral hemorrhage.

Key words:Bedside Doppler ultrasound| Percutaneous dilatational tracheotomy| Severe cerebral hemorrhage|Visualization|Operation safety