国际麻醉学与复苏杂志   2019, Issue (3): 0-0
    
机械通气患者经皮扩张气管切开术中气管导管精确再定位的临床研究
秦志均, 赵春燕, 罗雪梅, 张警, 王芳, 罗毅1()
1.四川省雅安市中医医院麻醉与重症医学科
Clinical study of accurate repositioning of endotracheal tube in percutaneous dilatational tracheotomy for patients undergoing mechanical ventilation
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摘要：

目的　探讨超声引导气管导管（endotracheal tube, ETT）退管和再定位在机械通气患者经皮扩张气管切开术（percutaneous dilatational tracheotomy, PDT）中应用的可行性和安全性。　方法　首先选择拟行全身麻醉的患者120例，在喉镜直视下测量门齿?蛳声门距离。再选择经口气管插管后拟行PDT的患者80例，采用随机数字表法分为常规切开组（T组）和超声引导组（U组），每组40例。T组采用颈部解剖标志、 U组采用超声确定穿刺点，切皮前T组将ETT退至20 cm（门齿与ETT对应刻度），U组在超声引导下将ETT套囊退至环状软骨水平。观察两组患者操作中气管穿刺、导丝置入一次成功率，穿刺针刺中ETT、套囊发生率，退出ETT时意外脱管率，操作中SpO2低于90%发生率，气管切开套管（percutaneous tracheostomy tube, PTT）置入成功率，操作时间。　结果　120例全身麻醉患者门齿-声门距离平均值为（16.7±1.1） cm［男性（17.1±1.1） cm，女性（16.2±1.0） cm］，最大值20.0 cm，最小值14.5 cm。U组气管穿刺一次成功率明显高于T组（P<0.05）；U组无穿刺针刺中ETT及套囊，T组穿刺针刺中ETT及套囊发生率分别为62.5%和42.5%，两组比较差异均有统计学意义（P<0.05）；U组操作中没有患者SpO2低于90%，T组患者SpO2低于90%的发生率为20%，两组比较差异有统计学意义（P<0.05）；U组操作时间明显低于T组（P<0.05）。两组患者PTT置入成功率、退出ETT时意外脱管率差异均无统计学意义（P＞0.05）　结论　超声引导ETT退出和再定位可避免PDT中ETT对操作的干扰，提高气管穿刺一次成功率，缩短操作时间，改善术中氧合。
关键词： 超声引导；　经皮扩张气管切开术；　气管导管
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To explore the feasibility and safety of ultrasound-guided endotracheal tube (ETT) withdrawal and repositioning during percutaneous dilatational tracheostomy (PDT) in patients with mechanical ventilation.　Methods　One hundred and twenty patients undergoing general anesthesia were selected and the incisor-glottic distance was measured under direct vision by the laryngoscope. Subsequently, eighty patients scheduled to undergo PDT were selected and divided into conventional incision group (group T) and ultrasound-guided group (group U) by Excel random number generation method, with 40 cases in each group. The puncture site was identified though anatomical landmarks in group T and real-time ultrasound guidance in group U respectively. Before incision, ETT was withdrawn to 20 cm (the incisors correspond to the ETT scale) in group T whereas the cuff of ETT was retracted to the level of the cricoid cartilage under ultrasound guidance in group U. The one-time success rate of trachea puncture and guide wire insertion were recorded and compared. The occurrence rate of ETT and cuff puncture, the rate of premature loss of airway control, operation time, the incidence of SpO2 less than 90% in the process of PDT and the success rate of percutaneous tracheotomy tube (PTT) insertion were also recorded and compared.　Results　The average incisor-glottic distance of one hundred and twenty patients was (16.7±1.1) cm [(17.1±1.1) cm for males and (16.2±1.0) cm for females], with a maximum of 20.0 cm and a minimum of 14.5 cm. The one-time success rate of trachea puncture in group U was significantly higher than that of group T(P＜0.05). ETT and cuff were not punctured in group U and the incidence of ETT and cuff puncture was 62.5% and 42.5%, respectively (P＜0.05). The incidence of SpO2 less than 90% in group T was 20% whereas desaturation was not occurred in group U(P＜0.05). The operation time in group U was significantly decreased than that of group T(P＜0.05). There was no significant difference in the success rate of percutaneous tracheostomy tube(PTT) insertion and the premature loss of airway control between two groups(P＞0.05). 　Conclusions　Ultrasound-guided ETT withdrawal and repositioning is feasible and safe. This method can avoid the interference of ETT in PDT, increase the success rate of tracheal puncture, shorten the operation time, and improve the oxygenation during operation.
Key words: Ultrasound guidance;　Percutaneous dilatational tracheostomy;　Endotracheal tube