CAJ | 학술논문

目的探讨超声引导下置管引流术在危重症患者抢救过程中的临床应用价值.方法回顾性分析2010年9月至2012年5月哈尔滨医科大学附属第一医院收治的经临床评估均不适宜立即行外科手术治疗的88例危重症患者,其中肝脓肿伴感染性休克患者24例,急性化脓性胆囊炎患者21例,重症急性胰腺炎患者19例,肾积水伴感染性休克患者19例,其他危重症患者5例.所有患者均行超声引导下不同脏器病灶的穿刺置管引流术.结果88例患者均一次穿刺置管成功,未发生严重术后并发症.穿刺2 d后,88例患者白细胞计数由(12.1±3.3)×109/L下降到(8.9±2.9)×109/L(t=13.856,P=0.005);体温由术前(38.9±0.8)℃降至(37.3±1.1)℃(t=9.238,P=0.012).88例患者中48例经保守治疗后好转出院,36例于症状好转后行择期手术治疗,4例患者因术前合并多器官衰竭而死亡.88例危重症患者置管引流术成功率为100%(88/88),有效率为95.5%(84/88).结论超声引导下穿刺置管引流术是危重症患者一种安全、有效的抢救方法,不仅可迅速有效的缓解症状,改善机体状态,还可以为择期手术治疗赢得时机.
목적탐토초성인도하치관인류술재위중증환자창구과정중적림상응용개치.방법회고성분석2010년9월지2012년5월합이빈의과대학부속제일의원수치적경림상평고균불괄의립즉행외과수술치료적88례위중증환자,기중간농종반감염성휴극환자24례,급성화농성담낭염환자21례,중증급성이선염환자19례,신적수반감염성휴극환자19례,기타위중증환자5례.소유환자균행초성인도하불동장기병조적천자치관인류술.결과88례환자균일차천자치관성공,미발생엄중술후병발증.천자2 d후,88례환자백세포계수유(12.1±3.3)×109/L하강도(8.9±2.9)×109/L(t=13.856,P=0.005);체온유술전(38.9±0.8)℃강지(37.3±1.1)℃(t=9.238,P=0.012).88례환자중48례경보수치료후호전출원,36례우증상호전후행택기수술치료,4례환자인술전합병다기관쇠갈이사망.88례위중증환자치관인류술성공솔위100%(88/88),유효솔위95.5%(84/88).결론초성인도하천자치관인류술시위중증환자일충안전、유효적창구방법,불부가신속유효적완해증상,개선궤체상태,환가이위택기수술치료영득시궤.
Objective To discuss the clinical efficacy of ultrasound-guided percutaneous puncture and drainage in treatment in critically ill patients .Methods A retrospective analysis of 88 cases of critically ill patients were made who were not suitable for surgical treatment the First Affiliated Hospital , Harbin Medical University from September 2010 to May 2012.These cases included liver abscess with septic shock (n=24),acute suppurative cholecystitis (n=21),severe acute pancreatitis (n=19),hydronephrosis with septic shock(n=19)and other conditions(n=5).All of the patients underwent ultrasound-guided puncture of lesions within different organs for percutaneous drainage .Results The percutaneous puncture and drainage was successfully accomplished in all 88 cases with a technical success rate of 100%(88/88).No serious complication occurred .Two days after the operation,the average number of white blood cells dropped from(12.1 ±3.3) ×10 9/L to(8.9 ±2.9) ×10 9/L(t=13.856,P=0.005),while the body temperature dropped from(38.9 ±0.8)℃ to(37.3 ±1.1)℃(t =9.238,P =0.012).Forty-eight patients showed obvious alleviation of symptoms and were discharged eventually .Selective cholecystectomy was carried out in 36 patients after obvious alleviation of symptoms .And 4 patient with preoperative multiple organ failure died after the procedure.Conclusions Ultrasound-guided percutaneous puncture and drainage is a safe and effective medical treatment for critically ill patients .It can not only quickly and efficiently alleviate the symptoms and improve the physical condition ,but also gain time for elective surgery .