- 期刊
改良式氣管內管導引氣切管置入術
Modified Intraoperative Tracheotomy Tube Insertion Technique in Guidance of a Small-bore Endotracheal Tube
摘要
背景：氣管切開術又稱為氣切手術，是一種於頸部建立人工氣道之常見手術。氣切管錯置為術中之併發症，可能造成延遲通氣供氧及氣管阻塞之潛在致命危險。本研究我們改良現行氣切手術中置放氣切管方式，以降低術中氣切管錯置之風險。方法：術前準備將氣切管套於小口徑氣管內管外，術中先把此氣管內管前端在充足視野下置入氣管內，並以其為導引置入氣切管。此設計兼具安全導引及同步進氣之功能，若有需要亦可短暫置入軟式內視鏡評估。本研究納入條件為自2018年6月至2019年5月接受氣切手術並願意選擇此改良方式之病患，此研究已經慈濟醫院倫理委員會認證並發放許可證書。排除條件為全身麻醉無法插管及重複氣切手術之病患。結果：此改良式氣管內管導引氣切管置入術安全且優良，應用於氣切手術可能避免氣切管錯置所引起之併發症。
並列摘要
BACKGROUND: Tracheotomy is frequently performed to set up an artificial airway bypassing the larynx. Tracheotomy tube misplacement is a potentially lethal intraoperative complication. In this paper, we introduce a modified tracheotomy tube insertion method to avoid a false passage. METHODS: We modified the method of tracheotomy tube insertion by using a small-bore endotracheal tube as a guidewire and evaluated the efficacy. The endotracheal tube was placed into the trachea under direct vision, and the tracheal tube was then inserted into the tracheal lumen. The guiding tube may also be connected to a ventilator for adequate oxygenation during a prolonged procedure, and a flexible fiberscope can be inserted into the tube shortly afterwards for tracheal evaluation. Patients requiring a tracheotomy were enrolled in this study from June 2018 to May 2019 at Hualien Tzu- Chi Hospital. Patients were excluded if they were considered unsuitable for general anesthesia via endotracheal tube, or if they received a revised tracheotomy procedure. RESULTS: A total of 24 patients received the novel tube placement procedure. The success rate for one-time tube insertion was 100% in an average time of 24 seconds. There were no intraoperative complications or late complications during the 1-month follow-up. CONCLUSIONS: This modified tracheotomy tube insertion method is a safe way to insert a tracheotomy tube and could be considered an alternative technique for a tracheotomy procedure to avoid false passage of the tracheotomy tube.
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