目的 探讨ICU床旁行气管切开术中意外发现甲状腺肿大的简易处理方法。方法 对我院ICU 48例床旁气管切开术中意外发现甲状腺肿大的处理方法进行回顾性分析，观察术中出血量、术后出血和切口感染情况。结果 48例患者术中出血量无明显增多，术后无继续出血，均未发生切口感染。结论 ICU床旁行气管切开术中，意外发现的甲状腺肿大并不少见，掌握简易有效的处理方法具有积极的临床意义。
目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
目的:探讨烧伤合并吸入性损伤患者行预防性气管切开的时机和可行性, 以提高治疗中、重度吸入性损伤的疗效。方法:对80例烧伤合并气道吸入性损伤患者的临床资料进行回顾性研究,按气管切开手术不同时机分为预防性气管切开组70例与紧急气管切开组10例。70例在烧伤后(5.2±2.1)h行气管切开术,和10例在烧伤后(23.24±2.36) h行气管切开术。比较两组患者相关生命体征、血氧分压、氧饱和度、呼吸频率及预后情况。结果: 预防性气管切开组气管切开术70例患者,解除上呼吸道梗阻、改善缺氧状况69例,死亡1例。紧急气管切开组10例,死亡6例。预防性气管切开组与紧急气管切开组比较死亡率有明显降低(Plt;0.01)。结论:烧伤合并中、重度吸入性损伤应及早进行预防性气管切开术,防止呼吸道梗阻,减少并发症,降低死亡率,手术时机选择在伤后5小时内为宜。
Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.
ObjectiveTo evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. MethodsFrom July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. ResultsAll PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. ConclusionReal-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.
ObjectiveTo explore the risk factors for tracheal stenosis caused by tracheotomy or intubation.MethodsFrom July 2010 to July 2020, a total of 44 patients were suffered with tracheal stenosis caused by tracheotomy or intubation at the First Affiliated Hospital of Hunan Normal University as case group (n=44), and 34 patients were suffered tracheotomy or intubation without tracheal stenosis as control group (n=34). The clinical application of intratracheal tube cuff diameter was investigated by univariate comparison, ROC analysis and multivariate logistic regression analysis.ResultsUnivariate analysis showed intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle >150%, intubation time>7d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections and replacement of tracheal tube≥ 2 were the influence factors of posttracheostomy tracheal stenosis (PTTS) and postintubation tracheal stenosis (PITS) (P<0.005). Multivariate Logistic regression analysis showed C/T>150% (OR=6.681, 95%CI: 1.164 - 38.363), intubation time>7d (OR=4.723, 95%CI: 1.413 - 15.779), tracheal intubations/tracheostomy ≥2 (OR=4.526, 95%CI: 1.133 - 18.083) and recurrent respiratory tract infections (OR=3.681, 95%CI: 1.177 - 11.513) were positively correlated with PTTS and PITS. The area under the ROC curve (AUC) of C/T>150% was 0.665 with the sensitivity of 0.364 and the specificity of 0.033 (95%CI: 0.555 - 0.775). AUC of intubation time>7 d was 0.717 with the sensitivity of 0.568 and the specificity of 0.133 (95%CI: 0.613 - 0.821). AUC of tracheal intubations/tracheostomy ≥2 was 0.683 with the sensitivity of 0.432 and the specificity of 0.067 (95%CI: 0.574 - 0.791). AUC of recurrent respiratory tract infections was 0.707 with the sensitivity of 0.614 and the specificity of 0.200 (95%CI: 0.603 - 0.811). However, there was no statistically significant difference C/T>150% and those clinical data in Z test (Z=0.839, P=0.402; Z=0.302, P=0.763; Z=0.751, P=0.453).ConclusionIntubation time>7 d, tracheal intubations/tracheostomy ≥2, recurrent respiratory tract infections, replacement of tracheal tube≥ 2 and C/T>150% are risk factors for PTTS and PITS.
【摘要】 目的 分析急性颈脊髓损伤后并发呼吸功能障碍的高危因素，以减少呼吸功能障碍发生，降低死亡率。 方法 对2002年7月-2006年8月收治的48例急性颈脊髓损伤患者，根据瘫痪程度、脊髓损伤平面、吸烟及年龄与呼吸功能障碍发生率的相关性，采用维持有效呼吸、颈部制动、减压复位内固定等相关措施，减少颈脊髓损伤患者术后并发呼吸功能障碍的发生。 结果 22例发生呼吸功能障碍；9例死亡，其中7例死于呼吸衰竭，1例心跳骤停死亡，1例合并脑干损伤死亡。 结论 全瘫、脊髓损伤平面高、吸烟、高龄是急性颈脊髓损伤并发呼吸功能障碍的高危因素，对高危患者气管切开、呼吸机辅助呼吸态度应积极。【Abstract】 Objective To analyze the high risk factors of respiratory obstacle after acute cervical spinal cord injury (SCI) and accept the measure more actively so as to decrease the respiratory obstacle occurrence and reduce the mortality rate. Methods A total of 48 patients from July 2002 to August 2006 were analyzed. According to the correlation among the paralyze degree,smoking, and age with the respiratory obstacle occurrence, we reduce the occurrence of respiratory obstacle in patients with spinal cord injury after the operation via obtaining the effective breath, neck retaining, etc. Results The respiratory obstacle was found in 22 cases; death in 9, in whom 7 died of respiratory failure, 1 of cardiac arrest, and 1 of brain stem hurt. Conclusions The whole palsy, higher level of the spinal cord injury, smoking, and advanced age are the high risk factors of respiratory obstacle after acute cervical SCI. The tracheostomy tube and the adjuvant respiration with the respirator should be accept aggressively for those high risk patients.
Objective To compare the efficacy and safety of different airway humidification methods in patients with tracheotomy in weaning process. Methods Twelve patients with tracheotomy in the medical intensive care unit ( MICU) of the First Affiliated Hospital of Sue Yat-sen University fromSeptember 2008 to August 2009 were enrolled in which 45 case /times weaning tests in three different humidification ways were performed( 15 cases in each group) . Wet square gauze method was used in group A and traditional intermittent wet fluid drip method was used in group B. In group C, MR850 humidifier device, RT200 Venturi tube and T tube device were used to perform humidification. Comparisons were carried out between the three groups on sputum viscosity, comfort of patients before and after humidification, length of weaning time, frequencies of irritating coughs and phlegm formation during test period. Sputum viscosity was evaluated by airway secretion score ( AWSS) .Results There was no significant difference of sputum viscosity assessed by AWSS in group A before and after humidification( P gt; 0. 05 ) while AWSS was significantly increased in group B and group C ( P lt;0. 01) , implied that sputum viscosity was significantly lower than that of group A ( P lt;0. 05) . The scores of patients’comfortwere 3. 0 ±0. 4, 5. 0 ±1. 2, and 8. 0 ±1. 7 in groups A, B, and C respectively which mean that the patients in group C felt more comfortable than those in group A and group B ( P lt;0. 01) . Cough frequencies of groups A, B and C per hour were 0. 8,2. 6,and 0. 4 times/hour respectively in which the frequency of group B was significantly higher than those of group A and group C ( P lt;0. 01) . The frequency of phlegm formation in group A was 7 times in 15-times offline record, which was significantly higher than those in group B and group C ( P lt;0. 01) . Conclusions For the patients with tracheotomy in weaning process, MR850 humidifier device, RT200 Venturi tube and T tube device for humidification is superior in reducing sputum viscosity and phlegm formation, improving patient comfort, and reducing the occurrence of irritating cough.