Walsh Edward M
Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
Resuscitation. 2006 May;69(2):335-8. doi: 10.1016/j.resuscitation.2005.08.005. Epub 2006 Feb 2.
The currently recommended method for rescue breathing in people who have had a laryngectomy is mouth-to-stoma. Even if they know what to do, by-standers are likely to find this technique unhygienic and therefore unacceptable. There is no equivalent of the pocket face mask for laryngectomees. This paper describes the practical differences that affect rescue breathing in patients with laryngectomy stomas and proposes a new use of a tracheal tube for rescue breathing in laryngectomees. Ten patients with permanent tracheal stomas scheduled for ENT surgery were ventilated successfully through a tracheal tube with the cuff applied to the outside of their tracheal stomas, following induction of anaesthesia and before the start of surgery. Observations of oxygen saturation, end-tidal carbon dioxide, expired tidal volume and chest movements were within acceptable limits. This device was simple to use and is hygienic and inexpensive. Laryngectomees' relatives, friends or carers with minimal training could use the tube in a mouth-to-tube-to-stoma technique should the need for rescue breathing arise. It could also be used by paramedic and medical staff in a mouth or bag-to-tube-to-stoma technique until a definitive airway can be inserted.
目前推荐的对喉切除患者进行急救呼吸的方法是口对口造口呼吸。即使旁观者知道该怎么做，他们也可能觉得这种方法不卫生，因此难以接受。对于喉切除患者，没有相当于简易面罩的设备。本文描述了影响喉切除造口患者急救呼吸的实际差异，并提出了一种气管导管在喉切除患者急救呼吸中的新用途。10例计划接受耳鼻喉科手术的永久性气管造口患者，在麻醉诱导后、手术开始前，通过将气管导管套囊置于气管造口外部成功进行了通气。血氧饱和度、呼气末二氧化碳、呼出潮气量和胸部运动的观察结果均在可接受范围内。该装置使用简单，卫生且价格低廉。如果需要进行急救呼吸，经过最少培训的喉切除患者的亲属、朋友或护理人员可以采用口对管对造口的技术使用该导管。在插入确定性气道之前，护理人员和医务人员也可以采用口或袋对管对造口的技术使用该导管。
