摘要
目的探讨环甲膜与气管前壁穿刺联合气管切开术在烧伤患者喉头水肿急救中的应用效果。方法2000年11月—2018年8月,笔者单位抢救急性喉头水肿重度或特重度烧伤患者22例,其中男18例、女4例,年龄17~68岁,合并头面颈部深Ⅱ度以上烧伤、轻度及以上吸入性损伤。2000年11月—2012年10月行单纯紧急气管切开术急救12例患者,2013年5月—2018年8月行环甲膜与气管前壁穿刺联合气管切开术急救10例患者。记录2种气管切开术的抢救情况和并发症情况。对数据行Fisher确切概率法检验。结果行单纯紧急气管切开术的12例患者中,抢救成功5例,气管切开过程中窒息死亡7例;行环甲膜与气管前壁穿刺联合气管切开术的10例患者中,抢救成功9例,因心律失常导致心搏骤停死亡1例。2种气管切开术的抢救成功情况比较,差异有统计学意义(P<0.05)。14例抢救成功的患者中,12例出现失眠及创伤后应激障碍表现,经对症处理14~45 d后缓解,未发生永久性缺氧性脑损害。结论在丧失预防性气管切开条件的情况下,烧伤患者急性喉头水肿急救难度较大。环甲膜与气管前壁穿刺联合气管切开术简便快速、成功率高,可使缺氧显著改善,是较为理想的急救方案。
Objective To explore the effect of tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall in emergency treatment of laryngeal edema in patients with burns.Methods From November 2000 to August 2018,22 patients with severe burn or extremely severe burn combined with acute laryngeal edema were rescued in the author′s unit,including 18 males and 4 females,aged 17 to 68 years.All patients were complicated with mild inhalation injury or above and more than deep partial-thickness burn to head,face,and neck.From November 2000 to October 2012,simple emergency tracheotomy was performed for 12 cases.From May 2013 to August 2018,tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall was performed for 10 cases.Rescue effect and complication of the two kinds of tracheotomy were recorded.Data were processed with Fisher′s exact probability test.Results Among the 12 patients treated with simple emergency tracheotomy,5 cases survived and 7 cases died of suffocation during tracheotomy.Among the 10 patients treated with tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall,9 cases survived and 1 case died of cardiac arrest caused by arrhythmia.There was statistically significant difference in successful rescue effect between the two kinds of tracheotomy(P<0.05).Among the 14 patients who were successfully rescued,symptoms of insomnia and post-traumatic stress disorder occurred in 12 cases,which were relieved after symptomatic treatment for 14 to 45 d without permanent hypoxic brain damage.Conclusions In case of loss of the condition of preventive tracheotomy,first aid of acute laryngeal edema of burn patient is very difficult.Tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall is simple and rapid with high successful rate and amelioration of hypoxia,which is an ideal plan for laryngeal edema.
作者
王强
朱典勇
于磊
马科
胡福兴
杨学林
Wang Qiang;Zhu Dianyong;Yu Lei;Ma Ke;Hu Fuxing;Yang Xuelin(Department of Burns and Plastic Surgery,the 80th Army Hospital of PLA,Weifang 261021,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2019年第11期811-813,共3页
Chinese Journal of Burns
关键词
烧伤
穿刺术
气管切开术
环甲膜
气管前壁
喉头水肿
窒息
Burns
Punctures
Tracheotomy
Cricothyroid membrane
Front tracheal wall
Laryngeal edema
Asphyxia
