单步经皮旋转气管切开术式改进在急危重患者中的应用

目的探讨单步经皮旋转气管切开术式的改进在急危重患者中抢救的应用前景和价值。方法选取2007年3月以来经治的35例各种原因致呼吸道梗阻而引起的呼吸极度困难患者为观察对象,应用单步经皮旋转气管切开术的基本术式,借鉴PDT穿刺技术替代床边纤支镜引导下直视穿刺方法,即在第1,2或2,3软骨环水平横行切开皮肤,切口长度=螺旋切开器的外径×π/2(切口长度=切割器周长/2,精确计算可减少损伤。),套管针接注射器后垂直穿刺进针(注射器内有2%利多卡因2 ml),同时回抽注射器,见有气泡就确定进入气管中。拔除针芯,置入导丝。将旋转切割器沿导丝旋入,退出切割器,置入气管导管即可。结果应用改进后的气管切开方法实施的手术,使患者均顺利建立了人工气道而获救,由于手术方法的改进有效地避免了纤支镜自身侵入性操作对气管壁损伤,减少了设备,简化了手术步骤,达到了床边纤支镜引导同等效果。结论改进后单步经皮旋转气管切开的术式更安全,可控性更强,准确性更高,更易于非外科专业技术人员操作,值得推广。

Application of Improved Single-step PercuTwist Technique in Critical Patients

Objective To investigate the application and value of improved single-step PercuTwist technique in critical patients.Methods Thirty five patients with dyspnea caused by airway obstruction from March 2007 were enrolled in the study.Referencing percutaneous dilatational tracheostomy,the basic surgical procedure of PercuTwist technique was adopted.The transverse skin incision was made between 1st and 2nd tracheal cartilage,or 2nd and 3rd tracheal cartilage;the length of incision were the diameter of spiral incision device ×π/2.The trocar with syringe(2% lidocaine 2 ml absorbed) was punctured vertically,and ensured it got into the traches.Removed of core needle and place the guide wire in.The rotary cutter was screwed along the guide wire into the traches.Then screwed out of the cutter and put the endotracheal tube in.Results All patients underwent a successfully artificial airway set by the improved methods of tracheotomy.The injuries caused by invasive operation of bronchofiberscope were avoided.The effects were the same as the bronchofiberscope.Conclusion The improved single-step PercuTwist technique is safe,steerable and accurate,easy to be operated by non-surgical technical personnel,and can be generalized in clinic.