超声引导下经皮气管切开术在颌面部多发伤并上呼吸道梗阻中的应用

Application of ultrasound-guided percutaneous tracheotomy in multiple maxillofacial injuries with upper respiratory tract obstruction

摘要:

目的 探讨超声引导下经皮气管切开术在颌面部多发伤并上呼吸道梗阻中的应用价值。方法 收集2016年5月—2020年10月颌面部多发伤合并急性上呼吸道梗阻患者8例，均入住重症医学科，均表现为中-重度呼吸困难，气管插管失败后均紧急行超声引导下经皮扩张气管切开术。结果 8例患者均一次穿刺成功，穿刺成功率100%；手术时间5~9 min，平均6 min；患者术中出血量4~12 mL；置管成功率100%。无一例发生手术相关并发症。结论 对颌面部多发伤合并急性上呼吸道梗阻患者气管插管失败后紧急行彩色多普勒超声引导下经皮扩张气管切开术不仅可快速、有效、安全开放气道，而且可提高成功率，降低手术相关并发症，具有良好的临床应用价值。

关键词:颌面部多发伤;上呼吸道梗阻;彩色超声;经皮气管切开

Abstract:

Objective To explore the application value of ultrasound-guided percutaneous tracheotomy in multiple maxillofacial injuries with upper respiratory tract obstruction.Methods A total of 8 patients with multiple maxillofacial injuries complicated with acute upper respiratory tract obstruction were collected from May 2016 to October 2020. All of them were admitted to the Department of Critical Care Medicine of our hospital,who were presented with moderate to severe dyspnea.After tracheal intubation failed, they underwent emergency ultrasonics guided percutaneous dilatation tracheotomy.Results The puncture success rate was 100% in all 8 patients.The operation time was 5~9 min, with an average of 6 min.The amount of intraoperative bleeding was 4~12 mL; The success rate of the catheterization was 100%. None of the patients had surgery related complications.Conclusion For patients with multiple maxillofacial injuries complicated with acute upper respiratory tract obstruction, emergency color Doppler ultrasound-guided percutaneous dilated tracheotomy can not only quickly, effectively and safely open the airway after tracheal intubation failure，but also improve the success rate and reduce surgery-related complications, which has good clinical application value.

Key words:Multiple maxillofacial injuries;Upper respiratory tract obstruction;Color ultrasound;Percutaneous tracheostomy