改良 Veress 针减压张力性气胸：随机交叉动物研究。
Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study.
机构信息
From the Division of Trauma, Critical Care and Emergency Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
出版信息
J Trauma Acute Care Surg. 2013 Dec;75(6):1071-5. doi: 10.1097/TA.0b013e318299563d.
BACKGROUND
The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.
METHODS
tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using χ.
RESULTS
Forty-three tension events were created in 16 swine (24 mVN, 19 NT) at 15 mm Hg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera.
CONCLUSION
Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.
背景
目前，使用大口径静脉导管治疗张力性气胸（tPTX）的院前标准护理方法失败率很高。我们为此开发了一种改良的 Veress 针（mVN）。本研究旨在评估 mVN 与 14 号针胸腔穿刺术（NT）在猪张力性气胸模型中的有效性和安全性。
方法
通过向猪胸部注入 CO2 使气压达到 15mmHg，在 16 只成年猪中建立 tPTX。当达到张力生理状态，即心输出量减少 50%时，将猪随机分为接受 mVN 或 NT 减压的两组。如果在 5 分钟内未能恢复 80%的基础收缩压，则交叉使用另一种设备。使用 χ²分析比较两种设备的成功率、死亡率和交叉使用的需求。
结果
在 16 只猪中，43 个张力事件在胸腔内压力为 15mmHg 时，使用 3.8L CO2 体积时创建（24 个 mVN，19 个 NT）。tPTX 导致收缩压从基线下降 48%，心输出量下降 73%，中心静脉压与肺毛细血管楔压相等的比例为 42%。所有接受 mVN 治疗的张力事件都在平均（SD）70（86）秒内成功缓解。NT 在平均（SD）157（96）秒内成功减压 4 次（21%）。4 只猪（21%）在 NT 减压后 5 分钟内死亡。在 5 分钟后张力事件持续存在的情况下（19 个 NT 中有 11 个）进行了交叉 mVN 减压，结果 100%缓解。mVN 和 NT 均未导致内脏意外损伤。
结论
胸腔充气产生了一种可靠且高度可重复的 tPTX 模型。mVN 在有效和安全治疗 tPTX 减压和生理恢复方面远优于 NT。应该进一步研究 mVN，以改进设备并在现场替代 NT。
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