经皮扩张气管切开术后常规胸部X线摄影的作用

Role of routine chest radiography after percutaneous dilatational tracheostomy.

作者信息

Kumar V M, Grant C A, Hughes M W, Clarke E, Hill E, Jones T M, Dempsey G A

机构信息

Critical Care Unit, University Hospital Aintree, Liverpool, UK.

出版信息

Br J Anaesth. 2008 May;100(5):663-6. doi: 10.1093/bja/aen038. Epub 2008 Mar 27.

DOI:10.1093/bja/aen038

PMID:18369239

Abstract

BACKGROUND

The role of routine chest radiography (CXR) after percutaneous dilatational tracheostomy (PDT) has been questioned.

METHODS

We performed a prospective observational study, on a mixed medical/surgical critical care unit in a university teaching hospital. We studied all patients undergoing PDT as part of their critical care management from November 1, 2003 until July 31, 2007. All PDTs were performed under bronchoscopic guidance. After PDT, we reviewed the immediate post-procedural films to assess the utility of routine postoperative CXR. For the purposes of CXR review, we considered a procedure to be either uncomplicated or technically difficult. Clinically relevant CXR findings were new barotrauma (pneumothorax, pneumomediastinum) or a significant change in consolidation from the pre-procedure film.

RESULTS

A total of 384 patients underwent PDT during the study period. Of these, 345 had immediate post-procedural CXRs available for review. There were 252 PDTs (73%) documented as uncomplicated. There were 93 (27%) technically difficult procedures, with 107 adverse events recorded. In 82 (24%) procedures, these difficulties were described as minor procedural complications [multiple attempts at needle insertion (> or = 3), minor bleeding or tracheal ring fracture]. Significant complications (mal-placement in the anterior mediastinum and major bleeding) were documented in 12 (3.5%) patients. New abnormalities were noted on 8 (2.3%) immediate post-procedural CXRs. In only one patient was there a new CXR change in an uncomplicated PDT.

CONCLUSIONS

Immediate CXR after uncomplicated PDT performed under bronchoscopic guidance rarely reveals unexpected radiological abnormalities. The role of CXR after PDT appears to be restricted to those patients undergoing technically difficult and complicated procedures. A change in practice to this effect will lead to reductions in both medical costs and exposure of staff and patients to ionizing radiation.

摘要

背景

经皮扩张气管切开术（PDT）后常规胸部X线摄影（CXR）的作用受到质疑。

方法

我们在一所大学教学医院的内科/外科混合重症监护病房进行了一项前瞻性观察研究。我们研究了2003年11月1日至2007年7月31日期间所有接受PDT作为重症监护管理一部分的患者。所有PDT均在支气管镜引导下进行。PDT后，我们复查了术后即刻的胸片，以评估常规术后CXR的效用。为了进行CXR复查，我们将手术视为简单或技术难度大的手术。临床相关的CXR表现为新的气压伤（气胸、纵隔气肿）或与术前胸片相比实变有显著变化。

结果

在研究期间，共有384例患者接受了PDT。其中，345例有术后即刻的CXR可供复查。记录显示252例（73%）PDT为简单手术。有93例（27%）手术技术难度大，记录了107例不良事件。在82例（24%）手术中，这些困难被描述为轻微手术并发症[多次尝试穿刺针（≥3次）、轻微出血或气管环骨折]。12例（3.5%）患者记录有严重并发症（前纵隔误置和大出血）。8例（2.3%）术后即刻CXR发现新的异常。仅1例简单PDT患者的CXR有新变化。