摘要目的:探讨0.9%氯化钠注射液灌注套囊下床旁多普勒超声引导下经皮气管切开术（PDT）在危重症患者中的应用价值。方法:选取吉林省人民医院重症医学科2022年9月至2024年4月收治的拟行气管切开术的危重症患者54例进行随机对照研究，采用随机数字表法分为常规组（27例）与超声组（27例），常规组采用经验性退管，超声组采用0.9%氯化钠注射液灌注套囊下超声引导退管。观察两组手术时间、血氧饱和度 < 90%发生率、刺中气管导管（ETT）或套囊发生率、退管至门齿距离、丙泊酚用量、切口长度及出血量。结果:两组患者手术均一次操作成功，未发生大出血、损伤血管及甲状腺、气胸等严重并发症。超声组刺中ETT或套囊发生率、手术时间、丙泊酚用量分别为3.7%（1/27）、（6.2±1.4）min、40（40，40）mg，均优于常规组的48.1%（13/27）、（9.8±2.7）min、80（70，80）mg（χ 2=23.19、 t=6.11、 Z=-6.29，均 P < 0.05）；超声组低氧血症发生率为0，低于常规组的29.6%（8/27），差异有统计学意义（ P < 0.05）；超声组退管至门齿的距离为18（17，18）cm，与常规组的18 cm相比，差异有统计学意义（ Z=-2.62， P < 0.05）；两组切口长度、出血量差异均无统计学意义（ P=0.652、0.878）。 结论:对气管插管机械通气患者行0.9%氯化钠注射液灌注套囊下床旁多普勒超声引导下PDT，能够减少手术时间，降低低氧血症、刺中ETT或套囊发生率，减少镇静药物的应用，提高了手术的准确性和安全性。

abstractsObjective:To investigate the application value of 0.9% sodium chloride injection for a balloon catheter in bedside Doppler ultrasound-guided percutaneous dilatational tracheostomy in critically ill patients.Methods:A randomized controlled study was conducted involving 54 critically ill patients who were scheduled for tracheostomy at the Intensive Care Medicine, Jilin Province People's Hospital, from September 2022 to April 2024. These patients were randomly divided into a conventional group ( n = 27) and an ultrasound group ( n = 27) using the random number table method. The conventional group underwent empirical extubation, while the ultrasound group received extubation guided by a balloon catheter filled with 0.9% sodium chloride injection under ultrasound guidance. The following parameters were observed in both groups: duration of operation, incidence of blood oxygen saturation < 90%, incidence of puncturing the endotracheal tube or balloon catheter, distance from extubation site to the incisors, dosage of propofol, length of incision, and amount of bleeding. Results:Both groups of patients successfully completed the procedure on the first attempt, with no significant complications such as extensive bleeding, vascular injury, thyroid damage, or pneumothorax. In the ultrasound group, the incidence of puncturing the endotracheal tube or balloon catheter, duration of operation, and dosage of propofol were 3.7% (1/27), (6.2 ± 1.4) minutes, and 40 (40, 40) mg, respectively, all of which were superior to those in the conventional group [48.1% (13/27), (9.8 ± 2.7) minutes, 80 (70, 80) mg, χ2 = 23.19, t = 6.11, Z = -6.29, all P < 0.05]. The incidence of hypoxemia in the ultrasound group was 0, which was significantly lower than that in the conventional group [29.6% (8/27), P < 0.05]. The distance from extubation site to the incisors in the ultrasound group was 18 (17, 18) cm, which was significantly different from 18 cm of the conventional group ( Z = -2.62, P < 0.05). There were no statistically significant differences in length of incision and amount of bleeding between the two groups ( P = 0.652, 0.878). Conclusion:Performing PDT under bedside Doppler ultrasound guidance with a 0.9% sodium chloride injection-filled balloon catheter in patients requiring mechanical ventilation can reduce procedure duration, lower the incidence of hypoxemia and puncturing of the endotracheal tube or balloon catheter, decrease the use of sedative medications, and enhance the accuracy and safety of the procedure.