住院醫師於活體豬隻施行氣管造口術之難易度評估

Preferential Techniques in Skin and Tracheal Wall Incisions for Tracheostomy: A Comparative Study Using Live Swine Models by Resident Physicians

鄭評嘉(Ping-Chia Cheng) ； 卓宗儀(Tsung-Yi Cho) ； 徐婉倫(Wan-Lun Hsu) ； 羅武嘉(Wu-Chia Lo) ； 王棨德(Chi-Te Wang) ； 鄭博文(Po-Wen Cheng) ； 廖立人(Li-Jen Liao)

《台灣耳鼻喉頭頸外科雜誌》 52卷1期 (2017/03) Pp. 1-7

https://doi.org/10.6286/2017.52.1.1

摘要

背景：氣切是重要的耳鼻喉科手術，住院醫師以往由專科醫師指導進行手術；對於氣切手術，不同的皮膚及氣管切開方式過去並沒有研究比較。本實驗利用豬隻氣切比較醫師對於不同切開技法的困難度評估。方法：由自願參加的住院醫師隨機分成兩組執行豬隻氣切，並比較四種技法：皮膚橫向切開、縱向切開；氣管壁橫向切開、開窗切開。手術以3個月大，25 kg重的豬隻行全身麻醉下氣管切開手術，模擬一般氣切手術情形。兩組別分別進行兩次實驗，並紀錄各組手術時間、出血量及併發症。執刀者主觀認為手術中不同技法之同意程度以1~5分表示（1： 強烈不同意；2： 不同意；3：中立；4：同意；5：強烈同意），並分析其結果。結果：共有13名住院醫師參與。各組手術時間小於30分鐘，失血量小於5 ml，均無急性併發症產生。皮膚橫向及縱向切開同意程度為3.85 ± 0.32 (平均 ± 標準差)及4.00 ± 0.41，兩者無明顯的統計差異(p-value = 0.52)。氣管橫向及開窗切開同意程度為4.08 ± 0.40及4.23 ± 0.26，兩者亦無明顯的統計差異(p-value = 0.98)。結論：執行氣切手術的住院醫師針對豬隻氣管切開手術皮膚切開(橫向、縱向)，氣管壁切開(橫向、開窗)手術技法的同意程度皆沒有統計差異；動物氣切練習有助於住院醫師了解手術設備及過程，以及增加對氣切手術信心。

關鍵字

Tracheostomy ； animal model（氣管切開手術 ； 動物實驗）

並列摘要

BACKGROUND: Although tracheostomy has been performed for decades, no study has yet compared doctors' preferences for the skin incisions and tracheal wall incision techniques in tracheostomy. In this study, a live swine model was performed and we compared doctors'preferences for different skin and tracheal wall incisions. METHODS: Thirteen volunteer resident doctors were randomly allocated to two groups. They used swine models to perform four tracheostomy procedures: a horizontal skin incision, a vertical skin incision, a horizontal tracheal wall incision, and a tracheal wall window creation. Four 3-month-old, 25 kg swine, under general anesthesia with oral intubation, and skin preparation were set as usual in the operating room. Four experiments were performed by 2 groups to compare different skin incision (horizontal & vertical) and tracheal wall incision (horizontal & window). We recorded the procedure duration, blood loss, and complications. The doctors' preference for each procedure was recorded on a scale of 1-5 (1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree), and the responses were statistically analyzed. RESULTS: The procedure duration was less than 30 minutes and blood loss was less than 5mL in all groups. There's no acute complication. The mean ± standard deviation scores of preference for the horizontal and vertical skin incision techniques were 3.85 ± 0.32 and 4.00 ± 0.41, respectively ( p = 0.52), and those for the horizontal tracheal wall incision technique and tracheal wall window creation were 4.08 ± 0.40 and 4.23 ± 0.26, respectively ( p = 0.98). CONCLUSIONS: No significant differences were found in the mean scores of preference for horizontal and vertical skin incision techniques as well as those for the horizontal tracheal wall incision technique versus tracheal wall window creation. Animal-model based tracheostomies can help resident doctors become familiar with the surgical equipment and procedures and improve operation competence.

並列關鍵字

Tracheostomy ； animal model