皮肤触诊法在非吸入性面颈部烧伤患者气管切开指征中的理论及应用研究  

Study on the theory and application of skin palpation as an indication for tracheotomy in patients with non-inhalation facial and neck burns

作　　者：王强 赵玉玲 楚妍 张丽君 于洵洲 沈羽廷 王娜娜 刘书锋 WANG Qiang;ZHAO Yu-ling;CHU Yan(Department of Burn Orthopaedics,80th Group Army Hospital,Weifang 261021,China)

机构地区：[1]陆军第80集团军医院烧伤整形外科,261021 [2]海军特勤疗养中心,266071

出　　处：《中国现代药物应用》2023年第5期56-59,共4页Chinese Journal of Modern Drug Application

基　　金：2021年军队医学科技青年培育计划(项目编号:21QNPY048)。

摘　　要：目的研究皮肤触诊法在非吸入性面颈部烧伤患者气管切开指征中的应用价值。方法385例面颈部烧伤患者为研究对象,随机分为研究组(184例)和对照组(201例)。建立下面部、颈部理论模型并进行逻辑推演。对照组采用常规法,研究组采用面颈部皮肤触诊法,分析理论模型,对比两组预防性与延迟性或急救性气管切开发生情况。结果经理论模型分析得出:①气管区域压力升高是导致外源性气道梗阻的主要原因;②面颈部烧伤深度越深,皮肤弹性丧失越大,距离气管越近,压力对气管的影响越大,发生外源性气道梗阻的可能性越大;③理论上设计皮肤触诊法感受气管及附近区域压力上升可用于对气管切开指征的判断。研究组延迟性或急救性气管切开发生率1.09%低于对照组的4.98%,差异有统计学意义(P<0.05)。结论气管区域压力升高是导致外源性气道梗阻的主要原因,皮肤触诊法感受局部压力是可行的方法。Objective To study the application value of skin palpation as an indication for tracheotomy in patients with non-inhalation facial and neck burns.Methods A total of 385 patients with facial and neck burns were studied and randomly divided into a research group(184 patients)and a control group(201 patients).Theoretical models of the lower face and neck were constructed and logically deduced.The control group used the conventional method,and the research group used the facial and neck skin palpation method to analyze the theoretical model and compare the occurrence of prophylactic tracheotomy and delayed or emergency tracheotomy in the two groups.Results The theoretical model analysis shows that:(i)the increase of tracheal regional pressure was the main cause of exogenous airway obstruction;(ii)the deeper the facial and neck burns,the greater the loss of skin elasticity,the closer to the trachea,the greater the influence of pressure on the trachea,and the greater the possibility of exogenous airway obstruction;(iii)theoretically,the design of skin palpation to feel the pressure rise in the trachea and nearby areas can be used to make a judgment on the indication of tracheotomy.The incidence of delayed or emergency tracheotomy in the research group was 1.09%,which was lower than 4.98%in the control group,and the difference was statistically significant(P<0.05).Conclusion The increase of tracheal regional pressure is the main cause of exogenous airway obstruction.Skin palpation is a feasible method to feel local pressure.

关 键 词：触诊 气管切开术 烧伤 模型 软物质 压力 弹性 冗余 

分 类 号：R644[医药卫生—外科学]