重症新型冠状病毒肺炎患者的环甲膜切开术：一项病例对照研究。
Cricotracheostomy for patients with severe COVID-19: A case control study.
作者信息
Mukai Naoki, Okada Masahiro, Konishi Saki, Okita Mitsuo, Ogawa Siro, Nishikawa Kosuke, Annen Suguru, Ohshita Muneaki, Matsumoto Hironori, Murata Satoru, Harima Yutaka, Kikuchi Satoshi, Aibara Shiori, Sei Hirofumi, Aoishi Kunihide, Asayama Rie, Sato Eriko, Takagi Taro, Tanaka-Nishikubo Kaori, Teraoka Masato, Hato Naohito, Takeba Jun, Sato Norio
机构信息
Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan.
Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan.
出版信息
Front Surg. 2023 Jan 17;10:1082699. doi: 10.3389/fsurg.2023.1082699. eCollection 2023.
BACKGROUND
Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients.
MATERIALS AND METHODS
Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation.
RESULTS
Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group ( = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group ( < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group ( = 0.04).
CONCLUSIONS
These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.
背景
气管切开术是治疗重症2019冠状病毒病（COVID-19）的重要手术。据报道，高龄和肥胖与重症COVID-19及长时间插管的风险相关，且重症COVID-19患者常使用抗凝剂；这些因素也与气管切开术的较高风险有关。环甲膜切开术是一种通过有意部分切除环状软骨来开放气道的改良手术，最近有报道称其在低位喉、肥胖、颈部僵硬和有出血倾向的病例中有用。在此，我们研究了环甲膜切开术对重症COVID-19患者的有效性和安全性。
材料与方法
本研究纳入了2021年1月至2022年4月期间接受环甲膜切开术且随访期≥14天的15例重症COVID-19患者。对照组为2015年1月至2022年4月期间接受传统气管切开术的40例与COVID-19无关的呼吸衰竭患者。从病历中收集的数据包括年龄、性别、体重指数、从插管到气管切开术的间隔时间、抗凝剂的使用、气管切开术的并发症以及拔管情况。
结果
COVID-19/环甲膜切开术组与对照组/传统气管切开术组在年龄、性别以及从插管到气管切开术的天数方面无显著差异。COVID-19组的体重指数显著高于对照组（ = 0.02）。COVID-19组抗凝剂的使用率显著高于对照组（ < 0.01）。两组间围手术期出血、皮下气肿和造口感染率无差异，而COVID-19组的造口肉芽明显较少（ = 0.04）。
结论
这些结果表明，环甲膜切开术对重症COVID-19患者是一种安全的手术。
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