摘要：
Objective To explore the effect of ultrasound guided percutaneous dilatation tracheotomy in critical ill patients.Methods From January 2016 to January 2018,95 critical ill patients who were treated in the People's Hospital of Quzhou were selected.According to the random number table method,they were divided into control group (n =47) and observation group (n =48).The patients in the control group were treated with traditional tracheotomy,and the patients in the observation group were treated with percutaneous dilatation tracheotomy under ultrasonic guidance.The operation condition of the two groups was observed,including operative bleeding volume,operative time,incision length,extubation time,incision healing time,hospitalization time and so on.The postoperative complications and mortality were recorded in the two groups.Results The operative bleeding volume,operative time,incision length and incision healing time in the observation group were (12.91 ± 1.36) mL,(10.05 ± 1.14) min,(1.46 ± 0.32) cm,(5.48 ±0.39)d,respectively,which were lower than those in the control group[(38.54 ± 3.47)mL,(27.43 ±2.29) min,(3.25 ± 0.68) cm,(7.64 ± 0.72) d],there were statistically significant differences between the two groups(t =40.098,39.616,13.888,15.381,P =0.000,0.000,0.000,0.000).The extubation time,hospitalization time in the observation group were (14.19 ± 1.14)d,(20.17 ± 1.85)d,respectively,which in the control group were (14.23 ± 1.17) d,(20.26 ± 1.89) d,respectively,there were no statistically significant differences between the two groups (t =0.142,0.198,P =0.886,0.843).The incidence rate of postoperative complications in the observation group was 6.25％,which was lower than 21.28％ in the control group,there was statistically significant difference between the two groups (x2 =9.515,P =0.002).The ICU mortality and hospitalization mortality in the observation group were 2.08％ and 4.17％,respectively,which in the control group were 10.64％ and 12.77％,respectively,there were no statistically significant differences between the two groups (x2 =2.937,2.277,P =0.087,0.131).Conclusion Ultrasound guided percutaneous dilatation tracheostomy can improve operation condition,reduce hospitalization time,and has less complications,low mortality,which has good clinical value in critical ill care.%目的 探讨超声引导下经皮扩张气管切开术在危重症患者治疗中的应用价值.方法 选取衙州市人民医院2016年1月至2018年1月收治的危重症患者95例,采用随机数字表法分为对照组(n=47)和观察组(n=48),对照组患者采取传统气管切开术,观察组患者采取超声引导下经皮扩张气管切开术,观察两组患者手术情况,包括手术出血量、手术时间、切口长度、拔管时间、切口愈合时间、住院时间等,并记录两组术后并发症发生情况及死亡情况.结果 观察组手术出血量、手术时间、切口长度及切口愈合时间分别为(12.91±1.36) mL、(10.05±1.14)min、(1.46±0.32) cm、(5.48±0.39)d,均低于对照组的(38.54±3.47) mL、(27.43±2.29) min、(3.25±0.68) cm、(7.64±0.72)d,组间差异均有统计学意义(t=40.098、39.616、13.888、15.381,P=0.000、0.000、0.000、0.000);观察组拔管时间、住院时间分别为(14.19±1.14)d、(20.17±1.85)d,对照组拔管时间、住院时间分别为(14.23±1.17)d、(20.26±1.89)d,组间差异均无统计学意义(=0.142、0.198,P=0.886、0.843);观察组术后并发症发生率为6.25％,低于对照组的21.28％,组间差异有统计学意义(x2 =9.515,P=0.002);观察组ICU死亡率、住院死亡率分别为2.08％、4.17％,对照组ICU死亡率、住院死亡率分别为10.64％、12.77％,组间差异均无统计学意义(x2=2.937、2.277,P=0.087、0.131).结论 超声引导下经皮扩张气管切开术可改善危重症患者的手术情况,减少住院时间,并发症较少,死亡率低,在危重症救治中具有良好的临床价值.
