摘要
目的：对比环甲膜穿刺反向引导气管切开术（ cricothyroid membrane puncture guided tracheostomy， CMPGT ）、气管切开术（ surgical tracheostomy， ST ）、环甲膜切开术（ surgical cricothyroidotomy， SC）和Griggs经皮导丝扩张钳气管造口术（ guide wire dilating forceps， GWDF）四种技术建立紧急气道的时间、效果和并发症。方法将20只小型猪随机（随机数字法）分为四组，麻醉后气管插管，通过阻塞插管使其血氧饱和度（ SpO2）降至80％。应用上述四种方法建立紧急气道，记录手术时间，监测并记录血氧饱和度等心电监护仪及动脉血气指标，记录术中及术后并发症并根据并发症评分表评分。结果所有小型猪均成功建立气道， SC、 GWDF、 CMPGT和ST的手术时间分别为（86±12） s，（165±63） s，（174±34） s和（519±128） s，但是CMPGT组的恢复通气时间最短，为（23±4） s ， P＜0.01。心电图显示停止供氧后T波降低和Q-T间期缩短， SpO2下降，通气后快速恢复正常水平。四组心电图和动脉血氧指标的术前和术后差异有统计学意义（ P＜0.05）。并发症方面，每组均有两只出现轻度出血。 ST组另有3只术中中度出血，3只出现低血压，1只术后轻度出血，并导致了创口周围感染。 SC组中，1只可见术中中度出血，1只有轻微的环状软骨损伤。通过纤维支气管镜发现 GWDF 组中1只小型猪有中度的气管内壁损伤。CMPGT、 GWDF、 SC和ST四组的并发症评分为3、5、9、19。结论动物实验证实相比ST、 SC和GWDF， CMPGT在建立紧急气道方面更具有时效性和安全性。
Objective To compare efficacy, time consumed and complications among cricothyroid membrane puncture guided tracheostomy （ CMPGT ） , surgical tracheostomy （ ST ） , surgical cricothyroidotomy （ SC） , and percutaneous tracheostomy using Griggs＇guide wire dilating forceps （ GWDF） for the establishment of airway in urgent need of medical attention.Methods Twenty miniature swine were randomly （ random number） divided into four groups.The procedures of CMPGT, ST, SC and GWDF were carried out when patients＇SpO2 （ oxygen saturation of blood ） declined to 80% by suspension of oxygen supply after general anesthesia. Procedure performed time, ventilation resumed time, SpO2 and electrocardiograph （ ECG） and arterial blood gases （ ABG） analysis including SaO2 , PaO2 , PaCO2 , blood pH, and heart rate, blood pressure were recorded.Fiberoptic bronchoscope was used to assess any damage to the tracheal wall.Complications were noted and scored in a two-month follow-up period.Results Airways were successfully established in all swine.The times consumed for SC, GWDF, CMPGT, and ST were （86 ±12） s, （165 ±63） s, （174 ±34） s, and （519 ±128） s, respectively, however a shorter time for ventilation resumed was found in CMPGT procedure （23 ±4） s, P〈0.01.ECG showed that SpO2 and T-wave decreased and Q-T shortened after oxygen suspension and recovered to normal level rapidly after ventilation.There were significant differences in ECG and ABG between pre-and post-operative periods （ P〈0.05） in all groups.Minimal intra-operative bleeding was found in two swine of each group.In ST group, moderate intra-operative bleeding was encountered in three swine.Three pigs were suffered from hypotension owing to prolonged hypoxemia.There was minimal postoperative bleeding occurred in one swine, thus leading to stoma infection.In SC group, moderate intra-operative bleeding was noticed in one swine. One miniature swine had slight injury at laryngeal cartilage resulting in difficult decannul
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第4期450-454,共5页
Chinese Journal of Emergency Medicine
