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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。
Objective To investigate the application prospect and value of single-step percutaneous spin-tracheotomy in emergency treatment of critically ill patients. Methods From March 2007 to March 2005, 35 cases of respiratory tract obstruction caused by respiratory tract obstruction caused by patients with extremely difficult breathing were observed, the application of single-step percutaneous rotation tracheostomy of the basic surgical procedures, with reference to PDT puncture instead of bed Under the guidance of the fiberoptic bronchoscopy, the method of direct-view puncturing is to cut the skin transversely on the 1st, 2nd or 2nd cartilage ring. The incision length is the outer diameter of the spiral incision x π / 2 (incision length = cutter circumference Length / 2, accurate calculation can reduce the damage.), Needle puncture needle after needle perpendicular injection (2% lidocaine syringe 2 ml), at the same time pumping the syringe, see the bubble to determine the access to the trachea. Remove the needle core, into the guide wire. Rotate the cutter along the guide wire, exit the cutter, and place it in the endotracheal tube. Results The improved tracheotomy method performed surgery, the patients were successfully established artificial airway rescued, due to the improvement of surgical methods to effectively prevent the invasive bronchoscopy operation of the tracheal wall damage and reduce the equipment, Simplify the surgical steps to achieve the same effect of bedside bronchoscopy. Conclusion The improved single-step percutaneous transthmatic tracheotomy is safer, more controllable, more accurate and easier to operate by non-surgical technicians and is worth promoting.