环甲膜切开术在紧急呼吸道管理中的应用分析

龙瑞清; 俞德顺; 刘卓慧; 杨晶; 张春海; 贾峰峰; 高竞逾

doi:10.13201/j.issn.1001-1781.2018.16.009

环甲膜切开术在紧急呼吸道管理中的应用分析

- 1. 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032);
- 2. 昆明医科大学第一附属医院急诊医学科
基金项目:
国家自然科学基金（No：81660175）；云南省应用基础研究[No：2017FE468（-195）]；云南省卫生科技项目（No：2018NS0156）

详细信息

通讯作者: 刘卓慧,E-mail:3238004203@qq.com

中图分类号: R768.1

收稿日期: 2018-04-12

Application of surgical cricothyrotomy in emergency and complicated airway management

- 1. Department of Otorhinolaryngology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China;
- 2. Department of Emergency Medicine, First Affiliated Hospital of Kunming Medical University

More Information

Corresponding author: LIU Zhuohui, E-mail: 3238004203@qq.com

Received Date: 12 April 2018

摘要

摘要: 目的：探索环甲膜切开在紧急呼吸道管理中作为首选方法的可行性。方法：分析27例行环甲膜切开术患者的临床资料等相关数据。结果：患者病因学分布主要为头面部或颈部重度外伤、喉狭窄、口底及颌下间隙感染等；首选环甲膜切开术作为气道管理者16例（A组），先行常规气管切开术中改行环甲膜切开者11例（B组），A组、B组平均气道开放时间分别为（58.12±24.41）s和（739.09±245.29）s，两组比较差异有统计学意义（P<0.01）。同时，根据患者是否仅行环甲膜切开术，分为仅行环甲膜切开组（14例）和环甲膜切开+气管切开组（13例），两组术中出血量差异有统计学意义[分别为（2.36±1.16）ml和（14.65±4.31）ml，P<0.01]。除1例术后因原发病死亡，4例因喉狭窄行喉扩张术带T型扩张管，2例双侧喉返神经麻痹患者未行进一步治疗而长期带管外，余20例患者平均带管时间为（12.35±7.29）d，未出现喉或气管狭窄等术后并发症，均顺利拔管。结论：环甲膜切开术快速安全，且操作简单易行，临床上发生紧急困难呼吸道管理时可作为快速开通呼吸道的首选方法。
- 环甲膜切开 /
- 气道开放 /
- 呼吸道管理 /
- 病因 /
- 并发症
Abstract: Objective: To explore the feasibility of intercricothyrotomy in emergency airway management.Method: Characteristics of 27 cases underwent surgical cricothyrotomy were analyzed.Result: The main causes of emergency were severe trauma of head and neck, larynx stenosis, interspaces infection of the floor of the mouth and submaxillary space, etc; all the patients were divided into 2 groups:surgical cricothyrotomy as the first choice (group A,16/27) and surgical cricothyrotomy after conventional tracheotomy (group B,11/27); The average time of opening airway for group A was much shorter than group B[(58.12±24.41)s, (739.09±245.29)s,respectively,P<0.01)]; Bleeding in group A (14 cases) was much less than group B (13 cases)[(2.36±1.16)ml, (4.65±4.31)ml,respectively,P<0.01]; Except 1 cases died from primary disease, 4 cases with laryngeal stenosis underwent laryngeal dilation with T type expansion tube and 2 cases of bilateral recurrent laryngeal nerve palsy, the average time with tracheal tube of the remaining 20 patients was (12.35±7.29)d, no postoperative complications such as larynx or tracheal stenosis were found. All of them were successfully extubation.Conclusion: Surgical cricothyrotomy procedure is fast and safe with simple and convenient that can be used as the preferred method of rapid airway opening when a critical respiratory tract was difficult to manage.
- surgical cricothyrotomy /
- airway opening /
- airway management /
- etiology /
- complication

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