Frei F J, Meier P Y, Lang F J, Fasel J H
Departement für Anästhesie, Universität Basel, Kantonsspital, Schweiz.
Anasth Intensivther Notfallmed. 1990 Jan;25 Suppl 1:44-9.
Percutaneous cricothyroidotomy may be a lifesaving procedure for airway obstruction, which cannot be relieved by endotracheal intubation and can be performed with specially designed instruments. A new device, the "Quicktrach", was evaluated by an anatomical preparation, flow and resistance measurements, and puncture of the cricothyroid membrane in 55 corpses. The size of the parts of the instrument (needle, plastic cannula, depth gauge) in relation to the size of the larynx is adequate, thus there is little likelihood of perforation of the posterior wall of the larynx. Resistance of the plastic cannula is sufficiently low to allow for adequate ventilation. The duration of time until the cannula is positioned properly in the trachea is significantly shorter, when an incision prior to the puncture is done (83 +/- 88 seconds without incision versus 35 +/- 41 seconds with incision; mean +/- SD). The "Quicktrach" is easy to apply even by inexperienced persons. The incidence of damage to the larynx (lesions including fractures of the thyroid, cricoid and 1. tracheal cartilage in 18%; soft tissue injury in 9%) is relatively high, however considering the live saving character of the procedure these numbers appear to be acceptable. Technical problems which occur with the use of the device are discussed and suggestions for improvement are made.
经皮环甲膜切开术对于气道梗阻可能是一种挽救生命的手术，当气管插管无法缓解梗阻时，可使用专门设计的器械进行该手术。一种名为“Quicktrach”的新装置在55具尸体上进行了解剖学准备、流量和阻力测量以及环甲膜穿刺评估。该器械各部分（针、塑料套管、深度测量仪）相对于喉部大小而言尺寸合适，因此喉后壁穿孔的可能性很小。塑料套管的阻力足够低，可实现充分通气。当在穿刺前进行切口时，套管正确置于气管内所需的时间明显缩短（无切口时为83±88秒，有切口时为35±41秒；平均值±标准差）。即使是没有经验的人也很容易使用“Quicktrach”。然而，喉部损伤的发生率（包括甲状腺、环状软骨和气管软骨骨折等病变占18%；软组织损伤占9%）相对较高，不过考虑到该手术的救命性质，这些数字似乎是可以接受的。文中讨论了使用该装置时出现的技术问题并提出了改进建议。
