目的:探讨烧伤合并吸入性损伤患者行预防性气管切开的时机和可行性, 以提高治疗中、重度吸入性损伤的疗效。方法:对80例烧伤合并气道吸入性损伤患者的临床资料进行回顾性研究,按气管切开手术不同时机分为预防性气管切开组70例与紧急气管切开组10例。70例在烧伤后(5.2±2.1)h行气管切开术,和10例在烧伤后(23.24±2.36) h行气管切开术。比较两组患者相关生命体征、血氧分压、氧饱和度、呼吸频率及预后情况。结果: 预防性气管切开组气管切开术70例患者,解除上呼吸道梗阻、改善缺氧状况69例,死亡1例。紧急气管切开组10例,死亡6例。预防性气管切开组与紧急气管切开组比较死亡率有明显降低(Plt;0.01)。结论:烧伤合并中、重度吸入性损伤应及早进行预防性气管切开术,防止呼吸道梗阻,减少并发症,降低死亡率,手术时机选择在伤后5小时内为宜。
目的:探讨行气管切开术抢救成功的重型颅脑损伤及高血压脑出血患者直接除管的安全性和可行性。方法:在507监护仪行SPO2监测和严密观察下,不经过试阻管而直接将气管套管拔除。结果:本组除1例患者因带管时间长,切口周围气管内炎性肉芽生长而重新插管外,其余患者呼吸平稳,呼吸道通畅,无呼吸急促、呛咳、紫绀及SPO2降低。结论:此法避免了传统除管前试阻管的繁锁和由阻管而引起的多种不良反应,有临床实用价值。
ObjectiveTo evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. MethodsFrom July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. ResultsAll PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. ConclusionReal-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.
目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
ObjectiveTo explore the risk factors for tracheal stenosis caused by tracheotomy or intubation.MethodsFrom July 2010 to July 2020, a total of 44 patients were suffered with tracheal stenosis caused by tracheotomy or intubation at the First Affiliated Hospital of Hunan Normal University as case group (n=44), and 34 patients were suffered tracheotomy or intubation without tracheal stenosis as control group (n=34). The clinical application of intratracheal tube cuff diameter was investigated by univariate comparison, ROC analysis and multivariate logistic regression analysis.ResultsUnivariate analysis showed intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle >150%, intubation time>7d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections and replacement of tracheal tube≥ 2 were the influence factors of posttracheostomy tracheal stenosis (PTTS) and postintubation tracheal stenosis (PITS) (P<0.005). Multivariate Logistic regression analysis showed C/T>150% (OR=6.681, 95%CI: 1.164 - 38.363), intubation time>7d (OR=4.723, 95%CI: 1.413 - 15.779), tracheal intubations/tracheostomy ≥2 (OR=4.526, 95%CI: 1.133 - 18.083) and recurrent respiratory tract infections (OR=3.681, 95%CI: 1.177 - 11.513) were positively correlated with PTTS and PITS. The area under the ROC curve (AUC) of C/T>150% was 0.665 with the sensitivity of 0.364 and the specificity of 0.033 (95%CI: 0.555 - 0.775). AUC of intubation time>7 d was 0.717 with the sensitivity of 0.568 and the specificity of 0.133 (95%CI: 0.613 - 0.821). AUC of tracheal intubations/tracheostomy ≥2 was 0.683 with the sensitivity of 0.432 and the specificity of 0.067 (95%CI: 0.574 - 0.791). AUC of recurrent respiratory tract infections was 0.707 with the sensitivity of 0.614 and the specificity of 0.200 (95%CI: 0.603 - 0.811). However, there was no statistically significant difference C/T>150% and those clinical data in Z test (Z=0.839, P=0.402; Z=0.302, P=0.763; Z=0.751, P=0.453).ConclusionIntubation time>7 d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections, replacement of tracheal tube≥ 2 and C/T>150% are risk factors for PTTS and PITS.
Objective To compare the advantages and disadvantages of the PercuTwist technique．Methods Clinical data of patients undergoing PercuTwist and traditional tracheostomy during Jan 2007 to Feb 2008 in the department of pulmonary disease of Changhai Hospital were collected and analyzed．Results Of 16 patients with PercuTwist，12 were males and 4 were females．The minimum platelet before operation was 15 X 109／L The mean operating time f from local anesthesia to connecting ventilator)was(4.3±1.0)min，and complications occurred in 2 cases with 2 incidences．Of the 12 patients with traditional tracheostomy，8 were males and 4 were females．The minimum platelet before operation was 85 X 109／L．The mean operating time was(33.3±8.6)min，and complications occurred in 8 cases with11 incidences．There were significant differences in complications and operating time between the patients with PercuTwist and the patients with traditional tracheostomy(P lt;0.001 or 0.01)．Conclusions Compared with the traditional surgical tracheostomy，the PercuTwist technique takes less operating time and causes fewer complications．
ObjectiveTo investigate the clinical efficacy of AIRVO2 respiratory humidification apparatus in patients with tracheotomy after successful weaning from mechanical ventilation in intensive care unit (ICU).MethodsOne hundred subjects were randomly divided into a control group (treated with the tracheotomy mask joint oxygen inhalation by heating humidifier, n=50) and an observation group (treated with AIRVO2 model, n=50) on the basis of conventional therapy. Blood gas indexes (pH, PaO2, PaCO2, PaO2/FiO2) and clinical data (heart rate, respiratory rate, SpO2, sputum viscosity) were recorded at 0 h, 6 h, 12 h, 24 h, 48 h, 72 h after weaning. Besides, the incidence of postoperative pulmonary infection, rapid shallow breathing index (RSBI), successful weaning rate from mechanical ventilation and daily cost of weaning between the two groups were compared at 72 h after weaning.ResultsAfter treatment, all observed data of the patients were obviously improved compared with those before treatment. The differences of humidification effects between the observation group and the control group at the same time point were statistically significant (P<0.05). The differences of heart rate, respiratory rate, and SpO2 between the observation group and the control group at the same time point were statistically significant (P<0.05). The improvement of PaO2 and PaCO2 at the same time point were statistically different between the observation group and the control group (P<0.05). Seventy-two hours after weaning, the incidence of postoperative pulmonary infection and RSBI in the observation group were significantly lower than those in the control group (P<0.05), successful weaning rate from mechanical ventilation in the observation group was significantly higher than that in the control group (P<0.05), and the average daily cost of weaning from mechanical ventilation in the observation group was lower than that in the control group (P<0.05). Nine patients in the control group and 1 patient in the observation group needed secondary mechanical ventilation due to hypoxemia.ConclusionThe therapy of AIRVO2 respiratory humidification apparatus combined with conventional treatment may achieve satisfactory effect for patients of successful weaning from mechanical ventilation with tracheotomy, and it is worthy of promotion in clinical use.
The rehabilitation experience of 20 patients with tracheostomy after lung transplantation was reported, and the key points of rehabilitation nursing included sequential oxygen therapy, airway clearance, diaphragm pacing, respiratory training, swallowing training, speech training, exercise training, and gastrointestinal function rehabilitation. Tracheostomy is conducive to airway management and offline extubation in patients assisted by long-term breathing, and promotes patient recovery and discharge through multidisciplinary collaborative rehabilitation nursing integrated case management.
Objective To explore the influence of different withdrawal time of trachea cannula on percutaneous dilational tracheostomy (PDT) in critically ill patients. Methods In this study, we retrospectively analyzed the clinical data of 185 critically ill patients experienced PDT, who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University from January 2015 to July 2017. The patients were divided into an early PDT group (EPDT group) and a delayed PDT group (DPDT group) according to the timing of withdrawing trachea cannula. Operation information such as operation time, blood loss and the incidence of complications were collected and compared between the two groups. Results Between the EPDT group and the DPDT group, there were no obvious differences in operation time (minutes: 6.5±2.6 vs. 7.3±3.5), amount of blood loss (ml: 5.2±2.8 vs. 6.0±3.4) or conversion to traditional operation (1.9% vs. 2.4%) (all P>0.05). Compared with the EPDT group, the DPDT group patients experienced more fluctuation of intraoperative vital signs, used more dose of sedative and analgesic drugs, and experienced higher occurrence of aspiration (18.3%vs. 5.6%), balloon burst (13.4% vs. 2.9%), guide-wire placing difficulty (11.0% vs. 1.9%) and tracheostomy cannula placing difficulty (14.6% vs. 2.9%) (all P<0.05). There were no statistical significances in postoperative complications such as postoperative-hemorrhage, pneumothorax, pneumoderm, the posterior tracheal injury or incision infection between the two groups (allP<0.05). More patients acquired postoperative pulmonary infection in the DPDT group than the EDPD group (12.2%vs. 5.8%, P>0.05), and there was no statistical significances in mechanical ventilation time between the two groups (days: 5.5±3.0vs. 6.0±2.5, P>0.05). Conclusions The operation and complications of PDT in critically ill patients are influenced by the timing of withdrawing trachea cannula. The standard procedure of withdrawing trachea cannula preoperatively may offer better clinical operability and lower technical risk.