自制可调节长度气管切开套管在一例肥胖患者气管切开中的应用

Application of self-made adjustable tracheal cannula in obese patients with tracheotomy

目的探讨自制可调节长度气管切开套管在肥胖患者气管切开中的应用效果。方法取相应型号的气管插管1根,在16cm处剪断,注意不能剪断气囊充气导管,沿着气囊充气导管纵向修剪,保留充气导管;取营养液“能全力”橡皮瓶塞1个,中间修剪和气管插管直径相同大小的洞,从气管插管尖端穿过套在气管插管上;取一次性氧气面罩修剪成蝶形固定翼,中间修剪同气管插管直径相同大小的洞,两翼边修剪长方形固定口,同法套在气管插管上橡皮瓶塞下面,固定翼和橡皮塞用缝线固定在一起;气管插管剪断的另一端套上接头,经供应室环氧乙烷消毒后备用。术中使用方法同普通气管切开套管,置入套管后根据患者颈部肥胖程度,通过上下移动橡皮塞而调节套管长度。结果自制可调节长度气管切开套管替代普通型号气管切开套管应用于肥胖患者,能根据患者颈部肥胖程度调节套管长度,顺利置入气管,保持患者气道通畅,有效排痰,连接呼吸机予机械通气,未发生滑脱;制作简单、取材方便,价格低廉。结论对于过度肥胖的患者使用自制可调节长度气管切开套管可以满足临床治疗需求,减轻患者经济负担。

Objective To explore the efficacy of self-made adjustable tracheal cannula in obese patients with tracheotomy.Methods A corresponding model of tracheal cannula was taken and cut with a length of 16cm.It is noted that the inflation catheter of the airbag should not be broken.A further trim was done along the longitudinal side of the inflation catheter.The inflation catheter was retained.A rubber cork from a nutrient solution bottle was chosen,and a hole was trimmed with the same length of the diameter of the tracheal cannula,through which the tracheal cannula was put.A disposal oxygen mask was trimmed into two wings like a butterfly,the middle of which was made into a hole with the same length of the diameter of the tracheal cannula.Two rectangular holes were made on the two wings in order to fit the rubber cork.The fixed wings of and rubber cork were put together through sutures.The other end of the tracheal cannula was cut and put on a connector and sterilized with ethylene oxide in the supply room.The intraoperative method was the same as the conventional tracheotomy.After the cannula was inserted,the length of the cannula was adjusted by moving the rubber cork up and down according to the obesity of the patient's neck.Results Compared with.regular tracheal cannula,the self-made adjustable tracheal cannula could be easily inserted into the trachea of patients no matter how obese their necks were.It could be connected to ventilator,keep patient's airway clear and effectively drain phlegm.No slippage was observed in our practice.It was simple,accessible and lower in cost.Conclusions The application of self-made adjustable tracheal cannula in obese patients with tracheotomy can meet the clinical therapeutic needs,and it also proves to be affordable for patients.