CAJ | 학술논문

目的比较环甲膜穿刺反向引导气管切开术(cricoid membrane puncture directed tracheostomy,CMPDT)、传统外科气管切开术(surgical tracheostomy,ST)和环甲膜切开术(cricothyroidotomy,CT)的手术时间、手术效果和并发症,探讨利用CMPDT建立紧急气道的有效性、安全性和可行性.方法将15只小型猪随机分为3组,每组5只.麻醉插管后建立小型猪低氧血症模型,待SpO2降至80％时(TO)分别应用上述3种技术建立气道,记录3组手术时间、术中多参数心电监护仪和动脉血气等指标及术中并发症.术后常规饲养小型猪2个月,由盲于实验分组的医师记录术后并发症并评分.结果所有小型猪均成功建立气道.术中心电图显示停止供氧后小型猪T波降低,Q-T间期缩短,恢复供氧后均很快恢复至正常水平.3组窒息前、TO和手术后的心率、血压、血氧饱和度(SpO2)、动脉血氧饱和度(SaO2)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)和动脉血pH的组间比较差异均无统计学意义.但是每组的TO和手术后指标比较有显著差异.CMPDT组的总手术时间为(174±34)s,ST组为(619±128)s,CT组为(86±12)s.但是CMPDT组恢复通气时间最短,为(23 ±4)s.ST组中3只小型猪出现了低血压,1只术后有轻度出血和创口轻度感染,经局部冲洗清创6d后痊愈.CT组1只有轻度喉部软骨损伤,拔管时略感困难,但并未发展为声门下狭窄.CMPDT、ST和CT3组的并发症总评分分别为3、13和9.结论 3种方法都可有效的恢复通气,其效果无明显差别,但是CMPDT可在更短的时间内恢复SpO2和其他生命体征,且评分较低.动物实验表明CMPDT通气速度快、手术时间短、并发症少,是一项快速、安全、有效的紧急气道技术.
목적 비교배갑막천자반향인도기관절개술(cricoid membrane puncture directed tracheostomy,CMPDT)、전통외과기관절개술(surgical tracheostomy,ST)화배갑막절개술(cricothyroidotomy,CT)적수술시간、수술효과화병발증,탐토이용CMPDT건립긴급기도적유효성、안전성화가행성.방법 장15지소형저수궤분위3조,매조5지.마취삽관후건립소형저저양혈증모형,대SpO2강지80％시(TO)분별응용상술3충기술건립기도,기록3조수술시간、술중다삼수심전감호의화동맥혈기등지표급술중병발증.술후상규사양소형저2개월,유맹우실험분조적의사기록술후병발증병평분.결과 소유소형저균성공건립기도.술중심전도현시정지공양후소형저T파강저,Q-T간기축단,회복공양후균흔쾌회복지정상수평.3조질식전、TO화수술후적심솔、혈압、혈양포화도(SpO2)、동맥혈양포화도(SaO2)、동맥양분압(PaO2)、동맥이양화탄분압(PaCO2)화동맥혈pH적조간비교차이균무통계학의의.단시매조적TO화수술후지표비교유현저차이.CMPDT조적총수술시간위(174±34)s,ST조위(619±128)s,CT조위(86±12)s.단시CMPDT조회복통기시간최단,위(23 ±4)s.ST조중3지소형저출현료저혈압,1지술후유경도출혈화창구경도감염,경국부충세청창6d후전유.CT조1지유경도후부연골손상,발관시략감곤난,단병미발전위성문하협착.CMPDT、ST화CT3조적병발증총평분분별위3、13화9.결론 3충방법도가유효적회복통기,기효과무명현차별,단시CMPDT가재경단적시간내회복SpO2화기타생명체정,차평분교저.동물실험표명CMPDT통기속도쾌、수술시간단、병발증소,시일항쾌속、안전、유효적긴급기도기술.
Objective To compare cricothyroid membrane puncture directed tracheostomy (CMPDT) with conventional surgical tracheostomy (ST) and cricothyroidotomy (CT) and to evaluate the feasibility, efficacy and safety of this novel technique.Methods 15 minipigs were divided randomly into 3 groups, 5 in each.After general anesthesia, CMPDT, ST and CT were performed respectively according to the established techniques when SPO2 reached 80％ (T0).Procedure duration, ECG and arterial blood gas results were recorded.Complications were recorded and scored according to an established score scale by an observer blinded to the grouping.Results Airway was successfully established in all animals (15/15).ECG monitor showed T-wave decreased and Q-T shortened after seasing of oxygen supply and both recovered rapidly to normal levels after reoxygenation.There were no significant differences between 3 groups in HR,BP, SPO2, SaO2, PaO2, PaCO2 and pH at pre-apnea, TO or post-operation, but with significant intragroup variation in the parameters before and after operation.The time for CMPDT, ST and CT was (174 ±34) s,(619 ± 128) s and (86 ± 12) s respectively.Three of 5 minipigs in ST group experienced hypotension due to longer time of hypoxia.1 and one had minor bleeding and stoma infection after surgery.One of 5 animals in CT group had minor laryngeal cartilage injury leading to difficult decannulation, postoperative fiber bronchoscopy showed no subglottic stenosis.The complication scores were 13, 9, and 3 for ST, CT and CMPDT, respectively.Conclusions All 3 methods can provide with effective airway access with no significant differences in ventilation effect, however CMPDT has short recovery time for SpO2 and other vital signs with the lowest complication score.The animal experiment suggests that CMPDT is a fast, safe and effective surgical technique for emergency airway.