环甲膜穿刺术与环甲膜切开术的临床应用

目的探讨环甲膜穿刺术与环甲膜切开术在临床中的应用。方法对Ⅳ度呼吸困难患者根据具体情况进行抢救，采用环甲膜穿刺19例（气管切开术前进行环甲膜穿刺15例，气管切开术中进行环甲膜穿刺4例），环甲膜切开6例。结果行环甲膜穿刺19例患者全部抢救成功。环甲膜切开患者均已成功插入气管套管，但仍有3例即时（1h内）死亡；1例24h后多器官功能衰竭而死亡；2例抢救成功，并于病情平稳后行常规气管切开。结论对大部分Ⅳ度呼吸困难的患者采用环甲膜穿刺结合气管切开可以解决气道通气问题。环甲膜切开术可适用于：血氧饱和度90％以下，呈快速进行性下降；上气道大出血随时有阻塞气道导致窒息危险；呼吸突然停止等病例。

Clinical application of thyrocricocentesis and thyrocricotomy

Objective To study the clinical application of thyrocricocentesis and thyrocricotomy. Methods Patients with Ⅳ-degree dyspnea were rescued with surgery, including thyrocricocentesis on 19 patients （ 15 before and 4 during tracheotomy） and thyrocricotomy on 6 patients. Results All the 19 patients accepting thyrocricocentesis were success- fully saved. Though tracheal cannula was successfully intubed in all 6 patients accepting thyrocricotomy, 3 patients died in one hour, 1 died 24 hours later due to multiple organ failure, and 2 were alive and accepted tracheotomy after their condition was stable. Conclusion Thyrocricocentesis combined with tracheotomy can remove airway obstruction in most patients with IV-degree dyspnea. Thyrocricotomy is applicable to patients whose blood oxygen saturation is 〈 90% and declined progressively and rapidly, and patients with suffocation induced by upper airway hemorrhea, and patients with sudden cessation of breath.