Sustić A, Kovac D, Zgaljardić Z, Zupan Z, Krstulović B
Department of Anaesthesiology and ICU, University Hospital Rijeka, Croatia.
Intensive Care Med. 2000 Sep;26(9):1379-81. doi: 10.1007/s001340000589.
The aim of this investigation was to evaluate the role of ultrasonography in avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died were removed en bloc at autopsy. The tracheas were opened along the membranous portion and the condition of tracheal rings and the site of tracheostomy macroscopically evaluated. The patients were divided in two groups: group A with 15 patients who underwent "blind" PDT and group B with 11 patients who underwent ultrasound-guided PDT. In five (33%) patients from group A, autopsy revealed that the tracheostomy tube was placed between the cricoid cartilage and the first tracheal ring (cranial misplacement) and in six (43%) patients a fracture of one tracheal ring was found. Cranial misplacement of the tracheostomy tube in patients from group B was not found (P < 0.05) and four (36%) patients had a broken tracheal ring (P = NS). The authors maintain that by using ultrasound-guided PDT cranial misplacement of the tracheostomy tube may be entirely avoided.
本研究的目的是评估超声检查在经皮扩张气管切开术（PDT）过程中避免气管切开管颅侧移位及气管环骨折方面的作用。对26例连续接受PDT但随后死亡的ICU患者的气管在尸检时整块切除。沿膜部切开气管，宏观评估气管环状况及气管切开部位。患者分为两组：A组15例接受“盲法”PDT，B组11例接受超声引导下PDT。A组5例（33%）患者尸检显示气管切开管置于环状软骨与第一气管环之间（颅侧移位），6例（43%）患者发现一个气管环骨折。B组患者未发现气管切开管颅侧移位（P<0.05），4例（36%）患者有气管环骨折（P=无显著性差异）。作者认为，使用超声引导下PDT可完全避免气管切开管颅侧移位。
