纤支镜引导下经皮气管切开术在重症医学科救治中的临床体会

目的观察纤支镜引导下经皮气管切开术(PDT)在重症医学科急危重症患者救治中的应用疗效。方法重症监护条件下,经气管导管插入纤支镜,穿刺套管针刺入气管内,纤支镜确认引导钢丝进入气管后,拔出套管针,用Ciaglia Blue Rhino(蓝犀牛)扩张器沿导丝充分扩开,气管导管置入气管内,拔出导丝及气管套管内芯,手术成功。结果 28例均操作顺利,手术时间短,出血少,术后无切口渗血、皮下血肿及皮下气肿等并发症。结论 PDT与传统气管切开术相比,具有出血少、操作简单、操作时间短、切口小、定位准确、并发症少的优点。     

经皮扩张气管切开术42例临床分析

对我院ICU收治的并发呼吸衰竭的42例重症患者行经皮扩张气管切开术。其中,19例仅做单纯的经皮扩张气管切开术(单纯组),23例在B超引导联合纤支镜直视下进行经皮扩张气管切开术(联合组)。比较两种术式所用时间、切口大小、术中出血量、缺氧时间、并发症情况。结果联合组上述观察指标(除并发症外)均较单纯组少,有统计学差异。采用B超引导联合纤支镜直视下进行经皮扩张气管切开术较单纯的经皮扩张气管切开术有更好的临床经过及疗效。     

应用新型经皮气管切开器行气管切开术的护理

目的探讨应用新型经皮气管切开器行气管切开术的护理配合。方法选取新型经皮气管切开器行气管切开术的ICU病房昏迷患者28例。均做好术前准备、术中配合,术后仔细观察,及时发现术后并发症。结果28例手术均取得成功,平均手术时间2min 15s,平均出血2mL,未出现气胸、大出血、气管食道瘘、喉返神经损伤、导管脱出等并发症。结论使用新型经皮气管切开器手术具有微创、操作简单、并发症少的优点,严密科学的护理配合与观察可保证手术成功实施,提高手术成功率。     

微创经皮气管切开术在困难气管切开患者中的疗效观察和使用技巧

目的 观察微创经皮气管切开术(PDT)在困难气管切开患者中的临床疗效.方法 我院2007年以来45例困难气管切开患者采用经皮扩张气管切开术,同期41例危重患者采用常规气管切开术.对比分析微创经皮气管切开术与常规气管切开术,总结困难气管切开患者经皮气管切开术的优点及应用技巧.结果 微创经皮气管切开术在困难气管切开患者中常规气管切开术明显缩短手术时间,减少术中及术后出血量,差异有统计学意义 (P＜0.01).结论 经皮扩张气管切开术具有简单、快速、损伤小的优点,缩短从决定气管切开到实施气管切开的时间,对于困难气管切开的临床应用有较大优势.     

采用牛角型扩张器经皮一步扩张法气管切开术的临床应用体会

目的：探讨经皮牛角型扩张器一步法气管切开术的临床应用方法及效果。方法：分析采用经皮牛角型扩张器一步法气管切开术的18例患者的手术时间,观察术中患者呼吸频率、心率、血压及血氧饱和度,出血量及并发症。结果：采用经皮导丝牛角型扩张器一步法气管切开术能一次性顺利扩张造瘘口,气管套管经插入器插入造瘘口顺畅,瘘口与气管切开套管匹配,平均手术时间（6±1.5）min,其中扩张造瘘口时间平均（20±5.5）s,插入气管套管时间平均（12±3）s出血少。术中呼吸频率、心率、血压、血氧饱和度无明显波动,术后出现1例纵隔皮下气肿。结论：经皮牛角型扩张器一步法气管切开术操作安全、简单、快速,值得临床应用推广。     

改良经皮旋转扩张气管切开术在SICU临床应用的效果评价

将164例有气管切开指征的重症监护患者,随机分为经皮旋转扩张气管切开术（A组）和改良经皮旋转扩张气管切开术（B组）,A组80例,B组84例,对两组的手术时间、成功率和手术并发症等进行比较。结果 B组手术时间明显短于A组（P〈0.05）;B组置管成功率及并发症明显优于A组（P〈0.05）。改良经皮旋转扩张气管切开术在手术时间、置管成功率及并发症发生率等方面有明显优势,值得在临床上进一步推广。     

床旁纤支镜引导下经皮单步旋转扩张气管切开术60例临床观察

目的 观察ICU床旁纤支镜引导下经皮单步旋转扩张气管切开术（PDT）的并发症情况。方法 应用PercuTwist标准气管切开组套，连续观察60例气管切开患者PDT相关并发症。结果 操作时出现少量出血2例。术后出现皮下气肿1例，围手术期并发症发生率5％；术后出现气孔黏膜肉芽增生2例，无气管瘘、创口感染等发生；44例拔管出院，平均气管切开时间为22天，拔管后3—9天气管造口自然闭合；16例气管切开后因疾病无法逆转而死亡。随访拔除套管患者仅2例因气管肉芽增生而出现咳嗽症状。结论 床旁纤支镜引导下PDT具有微创、组织损伤相对较小、出血量少、扩张过程相对可控、操作时间短、并发症发生率低等优点。     

纤维支气管镜引导下经皮气管切开术在重症监护病房中的应用

目的:比较在重症监护病房中纤维支气管镜(简称纤支镜)引导下的经皮气管切开术与无纤支镜辅助的经皮气管切开术的手术操作时间、围手术期和术后远期并发症的发生情况。方法:回顾分析江苏省常熟市第一人民医院重症监护病房2010年11月—2014年1月收治的73例气管切开患者的临床资料。根据有无纤支镜辅助将73例分为纤支镜引导下的经皮气管切开术组(A组,n=43)与无纤支镜辅助的经皮气管切开术组(B组,n=30),比较2组在经皮气管切开术中和术后近期及远期并发症发生情况。结果:2组手术操作时间差异无统计学意义(P0.05)。A组围手术期发生并发症4例,其中术后渗血48 h、切口感染各1例,皮下气肿2例;B组围手术期发生并发症15例,其中气胸、切口感染各1例,术后渗血48 h3例,皮下气肿5例,气管后壁、侧壁损伤5例。2组并发症发生率的差异有统计学意义(P0.05)。73例患者中33例得到随访。A组18例得到随访,其中仅2例发生并发症,1例诉声音嘶哑,1例喉部异物感。B组15例得到随访,其中2例发生并发症,1例诉声音嘶哑,1例吞咽困难。2组远期并发症发生率差异无统计学意义(P0.05)。结论:在纤支镜引导下行经皮气管切开术并不增加手术时间,但可降低围手术期并发症。     

纤支镜明视下经皮扩张气管切开术与传统气管切开术的临床对比研究

经皮扩张气管切开术（PDT）是近十几年开展起来的一种新的气管切开的方法，纤支镜明视下PDT是最近提出的一种方式，普遍认为其并发症比较少。作者所在两家医院于2005年6月至2006年6月，在纤支镜明视下行PDT术80例，并与同时期应用传统开放性气管切开术100例进行比较，结果报告如下。     

微创经皮气管切开术在困难气管切开患者中的应用

目的：观察微创经皮气管切开术在困难气管切开患者的临床疗效。方法：38例困难气管切开患者为观察组采用经皮扩张气管切开术,同期35例患者为对照组采用常规气管切开术。结果：观察组患者较对照组明显缩短手术时间,减少术中及术后出血量,缩短手术决策时间,差异有统计学意义（P〈0.001）。结论：经皮扩张气管切开术对于困难气管切开的病例仍有较大优势。     

Percutaneous nephrostomy

Nosebleed in a child usually involves the blood vessels in the anterior septal area and is fairly easy to treat. The physician applies firm pressure, a topical anesthetic, and petrolatum and, in some cases, inserts and positions packing. However, children with a disorder that predisposes them to nosebleed may require special measures. Dr McDonald reviews the anatomy of the nasal cavity, describes the causes of nosebleed from dryness to adenoidectomy, and explains how to manage this emergency.     

Percutaneous tracheostomy

Percutaneous tracheostomy using dilatation is a new technique for opening up the trachea whose use has become generalized in intensive care units since this method has numerous advantages over conventional tracheostomy and a lesser number of adverse effects. This article describes a nursing protocol for this technique; it reviews its most frequent complications and it details the nursing care which patients require once they have undergone.     

Percutaneous vertebroplasty

Percutaneous vertebroplasty is a minimally invasive procedure used to stabilise vertebral compression fractures caused by osteoporosis, haemangioma, myeloma, metastases and bone cysts. Acrylic bone cement is injected into the vertebral body to relieve pain and structurally reinforce the fracture. Interest in percutaneous vertebroplasty has grown as a result of technical procedural advances in radiology and the publication of an appraisal of, and guidelines for, the procedure by the National Institute for Clinical Excellence (2003). Nurses should be aware of the potential benefits of vertebroplasty and be involved in patient selection, and care of the patient before, during and after the procedure. Nurses should also be involved in audit analysis of the results of the procedure. More research into the effects of vertebroplasty is required and should involve nurses caring for this patient group.     

Percutaneous interventions

The catheterization laboratory is no longer limited to coronary arterial interventions. Physicians have been striving to make more interventions less invasive that now can include carotid, renal, and peripheral arterial stenting, as well as less invasive repair of atrial septal abnormalities. Even cardiac assist devices can be implanted percutaneously to bridge a critically ill patient to other modes of treatment. This article will give a brief overview of each intervention and identify important nursing care.     

Percutaneous tracheostomy

BACKGROUND: Percutaneous tracheostomy (PT) has gained an increasing acceptance as an alternative to the conventional surgical tracheostomy (ST). In experienced hands, and with proper patient selection, it is safe, easy and quick. COMPLICATIONS: Perioperative complications are comparable with those of ST and these are mostly minor. An important advantage of PT over ST is that there is no need to move a critically ill patient to the operating room and the rate of stomal infection is very low. Although data on late complications of PT are not yet sufficient, available reports show a favourable result. TECHNIQUES: Ciaglia's method is the most commonly applied, but no study has shown superiority of any of the percutaneous techniques described. The decision on which method to use should solely be made depending on the clinical situation and the experience of the operator. The learning curve demands caution, attention to detail and adequate experience on the part of the intensive care physician. Although PT is unfortunately declared 'easy', it must be left in the hands of experienced physicians to avoid unnecessary complications, and the risk of overimplementation should be kept in mind.