一次性经皮旋切器气管切开术在神经外科危重患者中的应用
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摘要
目的总结一次性经皮旋切器气管切开术在神经外科危重患者中的应用效果。方法使用一次性经皮旋切器气管切开术治疗神经外科危重患者55例,其中高血压脑出血30例,颅脑损伤16例,脑梗死、自发性脑出血各2例,烟雾病、动脉瘤、动静脉畸形、自发性蛛网膜下腔出血及脑膜瘤各1例。总结术中术后并发症,分析原因。结果 1例导丝扭曲,1例导丝磨损,2例导丝打折,为进导丝时气管插管未及时退管导致;1例因为皮肤切口过小出现术后皮下气肿;5例术中因疼痛刺激导致血压高,予以镇痛镇静;1例经皮旋切器气管切开后通气障碍转开放性气管切开术。结论在神经外科危重患者中应用一次性经皮旋切器气管切开术简便安全,值得推广应用。
Objective To conclude the application effect of the PercuTwist tracheostomy in the treatment for critical neurosurgical patients. Methods A total of 55 cases undergoing the PercuTwist tracheostomy were selected, including 30 cases with hypertensive cerebral hemorrhage, 16 cases with craniocerebral injury, 2 cases with cerebral infarction, 2 cases with spontaneous cerebral hemorrhage, and 1 case with moyamoya disease, arterial aneurysm, arteriovenous malformation,spontaneous subarachnoid hemorrhage and meningioma respectively. The intraoperative and postoperative complications were summarized and the causes were analyzed. Results 1 case had twisted guide-wire,1 case had worn guide-wire and 2 cases had flexed guide wire, which were caused by that the endotracheal intubation was not timely retreated when the guide-wire was entered; 1 case had postoperative subcutaneous emphysema due to too small skin incision; 5 cases had high blood pressure due to pain irritation, and analgesia and sedation were recommend. 1 case was transferred to open tracheostomy because of ventilatory function abnormalities after PercuTwist tracheostomy. Conclusion Application of PercuTwist tracheostomy in the treatment for critical neurosurgical patients is simple and safety. It is worth clinical promotion.
Objective To conclude the application effect of the PercuTwist tracheostomy in the treatment for critical neurosurgical patients. Methods A total of 55 cases undergoing the PercuTwist tracheostomy were selected, including 30 cases with hypertensive cerebral hemorrhage, 16 cases with craniocerebral injury, 2 cases with cerebral infarction, 2 cases with spontaneous cerebral hemorrhage, and 1 case with moyamoya disease, arterial aneurysm, arteriovenous malformation,spontaneous subarachnoid hemorrhage and meningioma respectively. The intraoperative and postoperative complications were summarized and the causes were analyzed. Results 1 case had twisted guide-wire,1 case had worn guide-wire and 2 cases had flexed guide wire, which were caused by that the endotracheal intubation was not timely retreated when the guide-wire was entered; 1 case had postoperative subcutaneous emphysema due to too small skin incision; 5 cases had high blood pressure due to pain irritation, and analgesia and sedation were recommend. 1 case was transferred to open tracheostomy because of ventilatory function abnormalities after PercuTwist tracheostomy. Conclusion Application of PercuTwist tracheostomy in the treatment for critical neurosurgical patients is simple and safety. It is worth clinical promotion.
引文
[1] FROVA G, QUINTEL M. A new simple method for percutaneous tracheostomy:controlled rotating dilation. A preliminary report[J]. Intensive Care Med, 2002, 28(3):299-303.
[2] YURTSEVEN N, AYDEMIRY B, KARACA P, et al.PercuTwist:a new alternative to Griggs and Ciaglia’s techniques[J]. Eur J Anaesthesiol, 2007, 24(6):492-497.
[3]NORA H C,LENA M N. Tracheostomy:epidemiology,indications, timing, technique, and outcomes[J]. Res Care,2014, 59(6):895-919.
[4] JOHN A K, DAVID J H. Tracheal ring fracture and herniation with PercuTwist percutaneous dilator[J]. Intensive Care Med, 2004, 30(6):1242-1243.
[5] EMMANUEL S, LOIC T, GILLES D. Tracheal ring fracture during a percutwist tracheostomy procedure[J]. Anesth Analg, 2004, 98(5):1451-1453.
[6] CHRISTIAN B, KLAUS W, DIRK M, et al. Single-dilator percutaneous tracheostomy:a comparison of PercuTwist and Ciaglia Blue Rhino techniques to facilitate access to the trachea the tracheal tube in place was withdrawn under direct laryngoscopy to the level of the glottic opening[J].Intensive Care Med, 2002, 28(9):1262-1266.
[7]李建国,马爱民,张少华,等.深静脉穿刺包在改良经皮扩张气管切开术中的效果评价[J].中国急救复苏与灾害医学杂志, 2009, 4(5):317-319.
[2] YURTSEVEN N, AYDEMIRY B, KARACA P, et al.PercuTwist:a new alternative to Griggs and Ciaglia’s techniques[J]. Eur J Anaesthesiol, 2007, 24(6):492-497.
[3]NORA H C,LENA M N. Tracheostomy:epidemiology,indications, timing, technique, and outcomes[J]. Res Care,2014, 59(6):895-919.
[4] JOHN A K, DAVID J H. Tracheal ring fracture and herniation with PercuTwist percutaneous dilator[J]. Intensive Care Med, 2004, 30(6):1242-1243.
[5] EMMANUEL S, LOIC T, GILLES D. Tracheal ring fracture during a percutwist tracheostomy procedure[J]. Anesth Analg, 2004, 98(5):1451-1453.
[6] CHRISTIAN B, KLAUS W, DIRK M, et al. Single-dilator percutaneous tracheostomy:a comparison of PercuTwist and Ciaglia Blue Rhino techniques to facilitate access to the trachea the tracheal tube in place was withdrawn under direct laryngoscopy to the level of the glottic opening[J].Intensive Care Med, 2002, 28(9):1262-1266.
[7]李建国,马爱民,张少华,等.深静脉穿刺包在改良经皮扩张气管切开术中的效果评价[J].中国急救复苏与灾害医学杂志, 2009, 4(5):317-319.