Bramwell K J, Davis D P, Cardall T V, Yoshida E, Vilke G M, Rosen P
Department of Emergency Medicine, UCSD Medical Center, San Diego, California 92103, USA.
J Emerg Med. 1999 May-Jun;17(3):433-6. doi: 10.1016/s0736-4679(99)00012-8.
When performing cricothyrotomy, once the initial incision has been created, the scalpel handle may be inserted into the incision and rotated, or a Trousseau dilator may be used to widen the opening. During endotracheal (ET) tube passage, the Trousseau dilator may be left in place or a tracheal hook may be inserted for tracheal stabilization. This experimental crossover trial of cricothyrotomy in a cadaver model compared: 1) scalpel handle rotation to the use of a Trousseau dilator in widening the initial incision, and 2) the use of a tracheal hook to a Trousseau dilator during ET tube passage. Part 1: Cricothyrotomy incisions were made in 30 formalin-fixed cadavers using a #11 scalpel blade. The opening was initially widened using a Trousseau dilator or a scalpel handle rotated through 360 degrees. Progressively larger ET tubes were passed using a tracheal hook for stabilization at the thyroid cartilage, and the size of the largest ET tube passed without significant resistance was recorded. Each opening was then widened using the other technique and ET tubes again passed as above. The dimensions of the opening after initial dilatation and after final ET tube passage were also recorded. Part 2: A tracheal hook inserted cephalad at the thyroid cartilage or a Trousseau dilator was used to stabilize the trachea during passage of progressively larger ET tubes, and the size of the largest ET tube passed without significant resistance was recorded. The insertion techniques were then reversed and ET tubes again passed as above. The trachea was inspected for damage and the balloon cuff checked for rupture after each attempt. Descriptive statistics were applied using a paired t-test and a chi-square analysis. We found no significant difference between the two techniques with regard to initial opening dimensions, final opening dimensions, or maximal ET tube size. There was no damage to local tissue and no balloon cuff ruptures. We found that the average size of the largest ET tube passed was significantly greater with the use of a tracheal hook (internal diameter mean 7.0 mm, median 7.0 mm) than with a Trousseau dilator (internal diameter mean 5.7 mm, median 5.5 mm). There was no damage to local tissue and no cuff ruptures. We conclude that the scalpel handle rotation technique is equal to the use of the Trousseau dilator with regard to opening size and maximal ET tube size but that use of a tracheal hook rather than a Trousseau dilator allows for passage of a larger ET tube in a cadaver model of cricothyrotomy.
在进行环甲膜切开术时，一旦做出初始切口，可将手术刀刀柄插入切口中并旋转，或者使用特鲁索扩张器来扩大开口。在插入气管内（ET）导管时，特鲁索扩张器可留在原位，或者可插入气管钩以稳定气管。这项在尸体模型中进行的环甲膜切开术的实验性交叉试验比较了：1）手术刀刀柄旋转与使用特鲁索扩张器来扩大初始切口，以及2）在插入ET导管期间使用气管钩与使用特鲁索扩张器的情况。第一部分：使用11号手术刀刀片在30具用福尔马林固定的尸体上做环甲膜切开术切口。最初使用特鲁索扩张器或旋转360度的手术刀刀柄来扩大开口。在甲状腺软骨处使用气管钩稳定气管，逐步插入更大尺寸的ET导管，并记录无明显阻力通过的最大ET导管尺寸。然后用另一种技术扩大每个开口，并再次按上述方法插入ET导管。记录初始扩张后和最终插入ET导管后的开口尺寸。第二部分：在逐步插入更大尺寸的ET导管期间，使用在甲状腺软骨处向头侧插入的气管钩或特鲁索扩张器来稳定气管，并记录无明显阻力通过的最大ET导管尺寸。然后颠倒插入技术并再次按上述方法插入ET导管。每次尝试后检查气管是否受损以及气囊套囊是否破裂。使用配对t检验和卡方分析进行描述性统计。我们发现，在初始开口尺寸、最终开口尺寸或最大ET导管尺寸方面，两种技术之间没有显著差异。局部组织没有损伤，气囊套囊也没有破裂。我们发现，使用气管钩时通过的最大ET导管的平均尺寸（内径平均7.0毫米，中位数7.0毫米）明显大于使用特鲁索扩张器时（内径平均5.7毫米，中位数5.5毫米）。局部组织没有损伤，套囊也没有破裂。我们得出结论，就开口大小和最大ET导管尺寸而言，手术刀刀柄旋转技术与使用特鲁索扩张器相当，但在环甲膜切开术的尸体模型中，使用气管钩而非特鲁索扩张器可使更大尺寸的ET导管通过。
