纖支鏡引導(dǎo)下經(jīng)皮氣管切開術(shù)在肥胖患者中的應(yīng)用

高鴻山， 高煥萍，楊萬勇

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纖支鏡引導(dǎo)下經(jīng)皮氣管切開術(shù)在肥胖患者中的應(yīng)用

高鴻山1， 高煥萍2，楊萬勇3

[摘要]目的：探討在纖支鏡引導(dǎo)下經(jīng)皮擴(kuò)張氣管切開術(shù)在肥胖患者中應(yīng)用價(jià)值。方法：將有氣管切開適應(yīng)證屬肥胖的危重患者58例，隨機(jī)分為經(jīng)皮氣管切開術(shù)(PDT)組30例，外科傳統(tǒng)開放性氣管切開術(shù)(OT)組28例，PDT組在纖支鏡引導(dǎo)下行經(jīng)皮擴(kuò)張氣管切開術(shù)。 比較2組術(shù)中出血量、手術(shù)時(shí)間、切口長度、拔管后切口愈合時(shí)間、一次性成功置管率以及并發(fā)癥發(fā)生情況。采用SPSS17.0軟件包對數(shù)據(jù)進(jìn)行處理。結(jié)果：PDT 組在術(shù)中出血量、手術(shù)時(shí)間、切口長度、切口愈合時(shí)間、一次性置管率及術(shù)后并發(fā)癥發(fā)生率方面明顯優(yōu)于OT 組，差異有顯著性(P<0.05)。結(jié)論：對于肥胖患者，在纖維支氣管鏡引導(dǎo)下行經(jīng)皮氣管切開術(shù),手術(shù)安全可靠。

[關(guān)鍵詞]經(jīng)皮氣管切開術(shù); 肥胖; 纖支鏡; 微創(chuàng)

Application of percutaneous dilation tracheostomy guided by bronchscopy in obesity patientsGAOHong-shan,GAOHuan-ping，YANGWan-yong．(TheCentralHospitalofZaozhuangMiningGroup,Shandong277000,China)

【Abstract】Objective：To evaluate the clinical value of percutaneous dilation tracheostomy guided by bronchscopy in obesity patients.Methods:58 obesity patients suitable for tracheostomy were randomly divided into 2 groups:a percutaneous dilation tracheostomy (PDT) group (30 cases) and an open tracheotomy (OT) group ( 28 cases).The PDT group underwent percutaneous dilation tracheostomy guided by bronchscopy.Bleeding, operation time, incision length, recovery time, one-time successful rate and complications of the two groups were analyzed with SPSS17.0 software package.Results:Compared with the OT group,the PDT group showed better results in terms of bleeding, time of operation, incision length,recovery time, one-time successful rate and complications(P<0.05).Conclusion:The safety and efficiency of percutaneous dilation tracheostomy guided by bronchscopy in obesity patients make it valuable in clinical application.

【Key words】Percutaneous dilation tracheostomy; Obesity; Bronchscopy; Minimally invasive

經(jīng)皮擴(kuò)張氣管切開術(shù)(percutaneous dilation tracheostomy，PDT)是一種新型、微創(chuàng)的氣管切開術(shù)式，與外科傳統(tǒng)開放性氣管切開術(shù)(open tracheotomy，OT)相比較，具有床旁操作，手術(shù)時(shí)間短，創(chuàng)傷小及出血少及并發(fā)癥少等特點(diǎn)[1]，在臨床上應(yīng)用越來越廣泛。對于肥胖患者，其頸部解剖位置不明顯，操作具有較大的盲目性，PDT應(yīng)用受到一定限制。對于這部分患者通常采用通過外科手術(shù)實(shí)施氣管切開。我科2015年1月-11月對30例具有氣管切開適應(yīng)證屬肥胖的危重患者，經(jīng)纖支鏡引導(dǎo)下行經(jīng)皮擴(kuò)張氣管切開術(shù)，回避了手術(shù)操作風(fēng)險(xiǎn)性，提高了成功率,現(xiàn)將報(bào)告如下。

1資料與方法

1.1一般資料參照《中國成年人超重和肥胖癥預(yù)防控制指南》標(biāo)準(zhǔn)，BMI>28 kg/m2的患者為肥胖患者[2]。選擇有氣管切開適應(yīng)證屬肥胖的危重患者58例，男37例,女21例，年齡17～83歲，平均年齡50歲。其……