用于战现场气道损伤救治的新型紧急气管切开装置

A new type of emergency tracheotomy device used in battlefield rescue

背景现代战场环境中气道损伤是导致可救治伤员死亡的重要原因,能否及时进行气道开放成为挽救气道损伤伤员生命的关键。紧急气道开放装置的研究具有现实需求。目的研发一种可用于战现场气道损伤紧急气管切开的刻度式气管切开撑开一体钳,探索战现场紧急气管切开新方法。方法使用18只小型猪,随机分为3组,每组6只,分别进行环甲膜切开术(surgical cricothyrotomy,SC)、外科气管切开术(surgical tracheotomy,ST)以及使用新研发的刻度式气管切开撑开一体钳快速气管切开术(scale-type tracheotomy and expansion pliers forceps,STEF),记录操作用时及血氧饱和度变化情况。结果18只小型猪均成功完成了气道开放,建立了通畅的呼吸通道。SC组、ST组、STEF组小型猪血氧饱和度达到90%以上用时分别为(60.0±4.8)s、(117.5±5.7)s、(28.3±2.8)s。血氧饱和度折线在上升阶段斜率分别为k_(SC)=1.56、k_(ST)=1.46、k_(STEF)=1.54,STEF组建立的气道通气效率与SC组、ST组基本相同。所有小型猪手术出血极少。结论使用刻度式气管切开撑开一体钳进行的紧急气管切开术在操作时间上优于环甲膜切开术与外科气管切开术,操作简便,在战现场气道损伤救治时具有明显的优势。

Background In the modern battlefield environment,airway injury has become an important cause of death of the curable wounded.Whether the airway can be opened in time has become the key to save the lives of many patients with airway injury.The research of emergency airway opening device has practical needs.Objective To develop Scale-type tracheotomy and expansion pliers forceps that can be used for emergency tracheotomy for airway injury at the battlefield.Methods Eighteen miniature pigs were randomly divided into surgical cricothyrotomy(SC)group,surgical tracheotomy(ST)group,and rapid tracheotomy with Scale-type tracheotomy and expansion pliers forceps(STEF)group,with six miniature pigs in each group.The operation time and changes in SpO_(2) were recorded.Results The airway opening was successfully completed in all miniature pigs,and unobstructed breathing channels were established.It took(60.0±4.8)s for SC group,(117.5±5.7)s for ST group,and(28.3±2.8)s for STEF group to achieve SpO_(2)≥90%,with minor bleeding.The SpO_(2) curve in the rising phase was k_(SC)=1.56,k_(ST)=1.46,k_(STEF)=1.54.The airway ventilation efficiency of STEF group was basically the same as that of SC and STgroups.Conclusion Emergency tracheotomy using scale-type tracheotomy and expansion forceps is superior to surgical cricothyrotomy and surgical tracheotomy in operation time,and it is easy to operate,which has obvious advantages in the treatment of airway injuries at the battlefield.