新型胸腔入口装置与针式减压在张力性气胸猪模型中的对比评估。
Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model.
机构信息
Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA; Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, Portland, OR, USA.
Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
出版信息
Am J Surg. 2018 May;215(5):832-835. doi: 10.1016/j.amjsurg.2017.12.014. Epub 2018 Jan 5.
INTRODUCTION
Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.
METHODS
Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n = 25), bladed trocar with 36Fr cannula (BTW, n = 16), bladed trocar alone (BTWO, n = 16) and surgical thoracostomy (ST = 11). Simulated tPTX was created to a pressure(p) of 20 mmHg.
RESULTS
Success (p < 5 mmHg by 120 s) was seen in 41 of 68 (60%) interventions. BTW and BTWO were consistently more successful than ND with success rates of 88% versus 48% in ND (p < .001). In successful deployments, ND was slower to reach p < 5 mmHg, average of 82s versus 26s and 28s for BTW and BTWO respectively (p < .001). Time to implement procedure was faster for ND with an average of 3.6s versus 16.9s and 15.3s in the BTW and BTWO (p < .001). Final pressure was significantly less in BTW and BTWO at 1.7 mmHg versus 7 mmHg in ND animals (p < .001).
CONCLUSION
Bladed trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression.
简介
张力性气胸（tPTX）仍然是创伤患者可预防死亡的主要原因。针式减压（ND）的失败率高达 60%。
方法
使用死后猪。干预措施随机分为 14G 针减压（ND，n=25）、带 36Fr 套管的刀片式穿刺器（BTW，n=16）、刀片式穿刺器单独使用（BTWO，n=16）和开胸手术（ST=11）。模拟 tPTX 至压力（p）为 20mmHg。
结果
在 68 次干预中有 41 次（60%）成功。BTW 和 BTWO 比 ND 更成功，成功率分别为 88%和 48%（p<.001）。在成功的部署中，ND 达到 p<.001 的速度较慢，平均为 82s，而 BTW 和 BTWO 分别为 26s 和 28s。ND 实施程序的时间更快，平均为 3.6s，而 BTW 和 BTWO 分别为 16.9s 和 15.3s（p<.001）。BTW 和 BTWO 的最终压力明显低于 ND 动物的 7mmHg，分别为 1.7mmHg（p<.001）。
结论
刀片式穿刺器可安全有效地治疗张力性气胸，成功率明显高于针式减压。
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