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经皮扩张气管切开术的改良技术。

A Modified Technique for Percutaneous Dilatational Tracheostomy.

机构信息

Clinical Neurology Research Center, Research Tower, Shiraz University of Medical Sciences, Shiraz, Iran.

Atilim University Medical School, Ankara, Turkey.

出版信息

J Intensive Care Med. 2023 Sep;38(9):878-883. doi: 10.1177/08850666231199005. Epub 2023 Aug 31.

DOI:10.1177/08850666231199005
PMID:37654071
Abstract

Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital. In this method instead of withdrawing the endotracheal tube (ETT) up close to the vocal cord and subglottic area at the beginning of the procedure, which is a common theme in PDT techniques with accidental extubation risk, we kept the ETT and gradually withdraw it. Of the 100 patients, the average age was 53.5 years, and 66% were males. On average, the procedure lasted 255 (67) seconds. All patients successfully underwent PDT with no life-threatening complications, accidental intraprocedural airway loss, or desaturation. As a result of this modified technique, PDT for airway management can be a safe and low-complication procedure without the risk of accidental intraprocedural airway loss. Moreover, omitting bronchoscopy and sonography during these procedures is cost-effective and secure.

摘要

经皮扩张气管切开术(PDT)广泛应用于机械通气患者,以促进脱机。本改良技术旨在降低与当前 PDT 技术相关的术中气道意外丢失和低氧血症风险。

这是一项单中心、前瞻性队列研究,纳入了 2022 年 9 月 8 日至 2023 年 1 月 18 日期间接受改良技术的 100 例患者。该程序在三级中心纳马齐教学医院的设拉子医科大学进行。在该方法中,我们没有像在具有意外拔管风险的 PDT 技术中那样,在开始操作时将气管内管(ETT)靠近声带和会厌下区域撤回,而是保留 ETT 并逐渐将其撤回。

100 例患者中,平均年龄为 53.5 岁,66%为男性。平均手术时间为 255(67)秒。所有患者均成功接受 PDT 治疗,无危及生命的并发症、术中气道意外丢失或低氧血症。

由于采用了这种改良技术,气道管理的 PDT 可以是一种安全且并发症少的程序,而不会有术中气道意外丢失的风险。此外,在这些操作中省略支气管镜和超声检查具有成本效益且安全。

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