Ambesh Sushil P, Pandey Chandra K, Srivastava Shashi, Agarwal Anil, Singh Dinesh K
Department of Anesthesiology and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Anesth Analg. 2002 Dec;95(6):1739-45, table of contents. doi: 10.1097/00000539-200212000-00050.
Percutaneous tracheostomy with single-step dilation technique using Griggs' guidewire dilating forceps (GWDF) is a well-recognized procedure. Recently, Ciaglia has introduced a one-step dilation technique using a curved, gradually tapered dilator, the Ciaglia Blue Rhino (CBR). In a prospective, randomized study, we performed percutaneous tracheostomy in 60 consecutive patients, using either the CBR or the GWDF technique. Postoperatively, all patients had bronchoscopy by a blinded consultant, and stoma characteristics and injuries to the trachea were studied. Mean tracheostomy time (skin incision to insertion of tracheostomy tube) in the two procedures (CBR 7.5 min versus GWDF 6.5 min) was not different (P > 0.05). The GWDF technique was associated with under-dilation and over-dilation of the tracheal stoma, each in almost one-third of patients. In the CBR group, the procedure was associated with a significant increase in peak airway pressure (P < 0.05) in all patients. There were nine cases of tracheal cartilage rupture, three cases of longitudinal tracheal abrasion, and one pneumothorax. Three patients had tracheal in-drawing at the scar site with huskiness of voice at 8 wk after decannulation; however, none had any breathing difficulty. We conclude that the techniques are equally effective in the formation of percutaneous tracheostomy. However, tracheal stoma over-dilation with GWDF and increase in peak airway pressure and rupture of tracheal rings with CBR remain major concerns.
The tracheas of 60 patients were cannulated through an artificial opening by using a single-step dilation technique with Ciaglia Blue Rhino or Griggs' dilation forceps. The techniques were equally effective for cannulation of the trachea. However, Ciaglia Blue Rhino was associated with rupture of tracheal rings in one-third of patients and increased airway pressure in all, whereas the Griggs' technique was associated with under- or over-formation of the tracheal opening, each in one-third of patients.
使用格里格斯导丝扩张钳（GWDF）的单步扩张技术进行经皮气管切开术是一种广为人知的手术。最近，恰利亚引入了一种使用弯曲、逐渐变细的扩张器——恰利亚蓝犀牛（CBR）的单步扩张技术。在一项前瞻性随机研究中，我们对60例连续患者分别使用CBR或GWDF技术进行经皮气管切开术。术后，由一位不知情的会诊医生对所有患者进行支气管镜检查，并研究造口特征和气管损伤情况。两种手术（CBR组7.5分钟与GWDF组6.5分钟）的平均气管切开时间（从皮肤切口到插入气管切开导管）无差异（P>0.05）。GWDF技术在近三分之一的患者中出现气管造口扩张不足和扩张过度的情况。在CBR组中，该手术在所有患者中均导致气道峰值压力显著升高（P<0.05）。有9例气管软骨破裂、3例气管纵向擦伤和1例气胸。3例患者在拔管后8周时瘢痕部位出现气管内陷且声音嘶哑；然而，无一例有呼吸困难。我们得出结论，这些技术在经皮气管切开术的形成中同样有效。然而，GWDF导致的气管造口过度扩张以及CBR导致的气道峰值压力升高和气管环破裂仍是主要问题。
通过使用恰利亚蓝犀牛或格里格斯扩张钳的单步扩张技术，对60例患者的气管进行人工开口插管。这些技术在气管插管方面同样有效。然而，恰利亚蓝犀牛在三分之一的患者中导致气管环破裂，在所有患者中导致气道压力升高，而格里格斯技术在三分之一的患者中导致气管开口形成不足或过度。
