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目的:探讨超声定位联合纤维支气管镜监视下经皮气管切开术(percutaneous dilational tracheotomy,PDT)在急诊重症病人中的临床疗效。方法:选择223例危重症患者,随机分成传统气管切开组(surgical tracheotomy,ST)(65例)、常规经皮气管切开置管(PDT)组(78例)和超声定位联合纤维支气管镜监视下PDT组(80例),分别给予传统气管切开术、常规经皮气管切开术和超声定位联合纤维支气管镜监视下经皮气管切开术治疗。观察并比较三组手术时间、手术切口长度、术中出血量、切口愈合时间、及术后并发症的情况。结果:超声定位联合纤维支气管镜监视下PDT组80例手术成功,常规PDT组75例手术成功。结论:超声定位联合纤维支气管镜监视下PDT术在减少操作的盲目性,提高安全性方面的效果显著,值得在有条件的急诊领域推广应用。
Objective: To investigate the clinical effect of ultrasound-guided percutaneous dilational tracheotomy (PDT) in emergency critical patients. Methods: Totally 223 critically ill patients were randomly divided into conventional tracheotomy (ST) group (65 cases), conventional percutaneous tracheotomy tube (PDT) group (78 cases) and ultrasound combined with bronchoscopy The PDT group (n = 80) under surveillance was treated with conventional tracheotomy, conventional percutaneous tracheostomy and percutaneous tracheotomy under ultrasound-guided bronchofibroscopy. The operation time, surgical incision length, intraoperative blood loss, incision healing time and postoperative complications were observed and compared. Results: Totally 80 cases of PDT under ultrasound and fiberoptic bronchoscopy were successfully operated, and 75 cases of conventional PDT were successfully operated. CONCLUSION: PDT with ultrasound and fiberoptic bronchoscopy is effective in reducing the blindness of operation and improving safety. It is worth to be popularized and applied in the field of conditional emergency.