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| 纤维支气管镜在经皮扩张气管切开术中的应用 |
| Application of fiberoptic bronchoscope in percutaneous dilatation tracheotomy |
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| DOI：10.12089/jca.2022.11.005 |
| 中文关键词: 纤维支气管镜 经皮扩张气管切开术 学习曲线 气切导管 |
| 英文关键词: Fiberoptic bronchoscopy Percutaneous dilatational tracheostomy Learning curve Tracheostomy tube |
| 基金项目:国家自然科学基金（81801380）；江苏省卫健委“科教强卫工程”医学青年人才项目（QNRC2016117） |
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| 中文摘要: |
目的 评估纤维支气管镜（FOB）对学习曲线内麻醉科医师行经皮扩张气管切开术（PDT）的应用价值。
方法 选择2020年9月至2022年1月行PDT的口腔癌患者60例，男47例，女13例，年龄18～80岁，BMI 15～28 kg/m2，ASA Ⅱ或Ⅲ级。随机分为两组：FOB引导下的PDT组（FP组）和无FOB引导的PDT组（NP组），每组30例。两组均在全麻经鼻气管插管后行PDT，FP组自穿刺至气切导管置入均在FOB引导下进行，NP组在盲视下进行。本研究中操作者均为PDT经验尚在学习曲线内的麻醉科医师，即PDT操作例数≤20例。记录入室时和置入气切导管即刻（置管即刻）HR、MAP，置管即刻 PETCO2，切口长度、PDT时间、首次置管成功率。记录术中出血、低氧血症、气管导管滑脱、气管后壁损伤、气管环断裂、皮下气肿、气胸等并发症发生率。
结果 与NP组比较，FP组PDT时间明显缩短（P<0.05），首次置管成功率明显升高（P<0.05），气管后壁损伤发生率明显降低（P<0.05）。两组置管即刻HR、MAP、 PETCO2、切口长度和术中出血、低氧血症、气管导管滑脱、气管环断裂、皮下气肿、气胸等并发症差异无统计学意义。
结论 采用FOB引导能够减少学习曲线内麻醉科医师的PDT时间，提高首次置管成功率并降低气管后壁损伤发生率，是实施PDT时较好的辅助方法。 |
| 英文摘要: |
Ojective To evaluate the application value of fiberoptic bronchoscopy (FOB) in guiding percutaneous dilatation tracheotomy (PDT) for anesthetists within the learning curve.
Methods Sixty patients who underwent PDT from September 2020 to January 2022 were selected, including 47 males and 13 females, aged 18-80 years, BMI 15-28 kg/m2, ASA physical status Ⅱ or Ⅲ. They were randomly divided into two groups: FOB-guided PDT group (group FP) and non-FOB-guided PDT group (group NP), 30 cases in each group. PDT was performed after nasotracheal intubation under general anesthesia in both groups. FOB guided the puncture and tracheotomy catheter placement in group FP, while a blind operation was conducted in group NP. In this study, all of the operators were anesthetists within the learning curve, with PDT experience less than or equal to 20 cases. HR and MAP were recorded when the patient entered the operating room. HR, MAP, and PETCO2 were recorded immediately after intubation. Incision length, PDT duration, and the success rate of the first intubation attempt were also recorded. Meanwhile, we assessed the incidence of complications in PDT, including intraoperative bleeding, hypoxemia, slipped tracheal tube, posterior tracheal wall injury, tracheal ring rupture, subcutaneous emphysema and pneumothorax.
Results Compared with group NP, the PDT duration was significantly reduced (P < 0.05), the success rate of the first intubation attempt was significantly higher (P < 0.05) and the incidence of posterior tracheal wall injury was significantly lower in group FP (P < 0.05). There were no significant differences in HR, MAP, PETCO2, incision length and other intraoperative complications, including intraoperative bleeding, hypoxemia, slipped tracheal tube, posterior tracheal wall injury, tracheal ring rupture, subcutaneous emphysema and pneumothorax between the two groups.
Conclusion With the guidance of FOB, the anesthetists within the learning curve could have performed PDT using less time with higher success rate of the first intubation attempt. FOB could also decrease the incidence of posterior tracheal wall injury after PDT. This study indicates that FOB should be a recommendation for the anesthetists within the learning curve when conducting PDT operation. |
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