急诊环甲膜切开术：一项值得了解的操作。

文献信息

中文摘要

声门下气道有两种可能入路： 气管切开术和环甲膜切开术。环甲膜切开术在头颈外科医生中较不为人熟知，且因喉部并发症而名声不佳，若未迅速改行气管切开术，可能进展为声门下狭窄。气管切开术在耳鼻喉科培训早期即被教授，尤其用于肿瘤性喉性呼吸困难患者在强化局部麻醉下实施。然而，它完全不适合其他紧急情况，如患者无法通气或气管插管失败，尤其是因解剖因素所致者。在此极端情况下，环甲膜切开术是首选处理。在某些危险的战时情况下，因作战原因禁忌气管插管且涉及具有集体影响的能力问题，可对清醒、轻度镇静的患者一线选择“战术性”环甲膜切开术。因此，法国陆军卫生部门的耳鼻喉科医生接受环甲膜切开术培训。我们在此介绍我们的操作技术，以及其在 civilian 紧急情况中作为一线处理的适应证和禁忌证，包括感染、创伤、肿瘤、过敏和/或水肿。

英文摘要

There are two possible approaches to the subglottic airway: tracheotomy, and cricothyroidotomy. Cricothyroidotomy is less well known by head and neck surgeons and has a bad reputation due to laryngeal morbidity, liable to progress to subglottic stenosis if not swiftly relayed by tracheotomy. Tracheotomy is taught early on in ENT training, notably to be performed under enhanced local anesthesia in patients with tumoral laryngeal dyspnea. It is, however, completely unsuited to other emergency situations, in patients that cannot be ventilated or in case of failure of orotracheal intubation, notably due to anatomic factors. Cricothyroidotomy is the attitude of choice in this extremity. In certain hazardous wartime situations, where orotracheal intubation is contraindicated for operational reasons and issues of capacity with collective impact, "tactical" cricothyroidotomy can be chosen in first line in an awake patient under mild sedation. The French Army Health Service ENT physicians are therefore trained in cricothyroidotomy. We here present our procedural technique, with indications and contraindications in first line in civilian emergency situations of infection, trauma, tumor, allergy and/or edema.