建立人工气道的新技术-环甲膜穿刺反向引导气管切开术动物实验  

A novel technique for airway cricothyroid membrane puncture directed tracheostomy: Preliminary experiment in minipigs

作　　者：陈犹白 王珊 张海钟[3] 

机构地区：[1]解放军医学院,北京100853 [2]卫计委卫生发展研究中心,北京100191 [3]解放军总医院口腔颌面外科,北京100853

出　　处：《解放军医学院学报》2015年第9期928-931,943,共5页Academic Journal of Chinese PLA Medical School

基　　金：首都医学发展科研基金(2009-3050);全军"十二五"课题面上项目(CWS11J095)~~

摘　　要：目的介绍环甲膜穿刺反向引导气管切开术(cricothyroid membrane puncture directed tracheostomy,CMPDT)及其在建立人工气道中的应用。方法将6只小型猪麻醉后建立低氧血症模型。应用环甲膜穿刺反向引导气管切开术建立人工气道,分别记录手术开始至通气供氧和手术开始至气管插管的手术时间,监测并记录血氧饱和度等多参数心电监护仪指标,利用纤维支气管镜观察气管内壁损伤等术中并发症。术后常规饲养小型猪1年,观察并记录术后近期和远期并发症。结果所有小型猪(6/6)均快速通气并成功建立人工气道,从实验开始至成功通气的时间为(18±5)s,从实验开始至成功插管的时间为(174±34)s。1只中量出血;1只发生气管内壁的轻微划伤,伤口表浅,长度约2 mm,未见术后近期和远期并发症。结论动物实验证实CMPDT是一项快速、安全、有效的气管切开技术,有望成为一项新的外科人工气道技术。Objective To introduce a novel technique for tracheostomy： cricothyroid membrane puncture directed tracheostomy（CMPDT） and its application in airway establishment. Methods Six minipigs were endotracheal intubated after anesthesia. Tracheal tube was blocked deliberately to simulate a hypoxia situation. CMPDT was used to establish airway when SpO2 decreased to 80%. Operation time from start（t0） to successful ventilation（t1） and to successful intubation via tracheal opening（t2） was recorded. Sp O2 and other vital signs including ECG, BP and HR were monitored by multi-functional ECG monitor. Intraoperative complications like tracheal wall injury were observed via fiberobronchoscopy. The minipigs were raised for 1 year after operation, and the short-term and long-term postoperative complications were also recorded. Results Quick ventilation and successful definite airway were achieved using CMPDT technique in all minipigs. The operation time from t0 to t1 and t0 to t2 was 18±5 s and 174±34 s, respectively. No vital signs were violently fluctuated except Sp O2 increased continually since ventilation. Five minipigs experienced minor bleeding and 1 minipig went through medium bleeding without surgical treatment. No other complications occurred, while 1 minipig’s tracheal wall was slightly scratched by dilatational forceps during the dilating procedure. Conclusion The animal experiment shows that CMPDT is a fast, safe and effective tracheostomy technique in minipigs, which can be an optional choice for tracheostomy.

关 键 词：人工气道 气管切开术 动物实验 环甲膜切开术 气管插管 

分 类 号：R459.7[医药卫生—急诊医学]