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研究生:陳律霖
研究生(外文):Albert Chen
論文名稱:以燈杖行氣管插管的透照形態:在大體上的研究
論文名稱(外文):Transillumination Pattern During Lightwand Tracheal Intubation:Study in Human Cadavers
指導教授:賴賢勇
指導教授(外文):Hsien-Yong Lai
學位類別:碩士
校院名稱:慈濟大學
系所名稱:整合生理暨臨床科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
畢業學年度:96
語文別:中文
論文頁數:32
中文關鍵詞:氣管插管燈杖
外文關鍵詞:Tracheal intubationLightwand
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利用燈杖行氣管插管已經被證實是一種有效而且簡單的替代性插管技術。然而,並無研究去探索頸部前區的透照形態。利用可攜式插管用內視鏡,在十一位大體老師身上,將氣管內管/ TrachlightTM 組裝單位的尖端分別放置於以下八個位置:﹙1﹚聲門內;﹙2﹚會厭軟骨基部;﹙3﹚會厭軟骨中部;﹙4﹚會厭軟骨頂部;﹙5﹚谿;﹙6﹚右側梨狀竇;﹙7﹚左側梨狀竇,以及﹙8﹚食道內。我們利用攝影的方式將其在頸部前區的透照形態做紀錄並用蒙蔽式方法分析結果。當氣管內管/ TrachlightTM 組裝單位的尖端放置入聲門,每一個大體老師都可見光度最大、圓形或橢圓形的亮光,而位置就正好在正中線、環狀軟骨甲狀軟骨交界處的下方。在燈杖置於會厭軟骨基部,會有圓形及倒三角形的亮光位於環狀軟骨甲狀軟骨交界處或於交接處上方一點的位置。隨著燈杖往大體老師的會厭軟骨中部;會厭軟骨頂部;及谿移動,亮光不是消失,便是減弱。然而,亮光的形狀及位置卻不會改變。當氣管內管/ TrachlightTM 組裝單位的尖端放置在梨狀竇時,會觀察到偏離中線,位於側頸部,甲狀軟骨的高度的圓形亮光。有二位大體老師產生兩處亮光。另一處亮光比較微弱,位於環狀軟骨甲狀軟骨交界處或於交接處上方一點的位置。只有一位大體老師產生兩側透照形態不對稱的情形,在左側梨狀竇產生兩處亮光,在右側梨狀竇產生三處亮光,多一處的亮光位於側頸部環狀軟骨的高度。將燈杖置入食道中。兩位大體老師,在頸部前區產生透照。有一位大體老師則在左側較逺的側頸部;環狀軟骨的高度,產生長條形的亮光。另一位大體老師,則在頸部前區產生與其本身位於右側梨狀竇相似的透照形態。利用透照的光線引導,行氣管插管,除了氣管內管/ TrachlightTM 組裝單位的尖端進入聲門,否則將會在頸部前區產生多樣性但可預測的亮光。在正中線、環狀軟骨甲狀軟骨交界處的下方的明亮、圓形或橢圓形的亮光,可視為氣管內管/ TrachlightTM 組裝單位的尖端已經通過聲門的可靠形態。
Tracheal intubation using lightwand has proven to be an effective and simple alternative technique. However, no study has explored the transillumination pattern in the anterior neck. Using fiberoptic scope, we verified the eight locations (inside the glottic opening; the base, middle portion and tip of the epiglottis; vallecula; bilateral piriform sinuses; and the esophagus) of the tip of the endotracheal tube-TrachlightTM (ETT-TL) unit in eleven human frozen cadavers. The glows in the anterior neck were photographed for a blinded review. When the ETT-TL tip was placed inside the glottic opening, a brightest; round or oval glow could be consistently seen in the midline just below the cricothyroid junction in each cadaver. If the ETT-TL tips were positioned at the base of the epiglottis, there is a round or reverse triangular glow at or just above the cricothyroid junction. As the ETT-TL tip moved from middle portion; tip of the epiglottis to the vallecula, the glow might vanish or become darker. However, the morphology and the location of the glow would be the same. When the tip of the ETT-TL lain in one of the piriform sinus, a round glow could be seen off the midline at the thyroid cartilage level. Two frozen cadavers showed two glows in each piriform sinus location, the other one was darker in the midline at or slight above the cricothyroid junction. In one frozen cadaver, Asymmetric transillumination was seen; the left side showed two glows, the right side three glows with additional one off the midline at the cricoid cartilage level. When the tip of the ETT-TL unit is placed in the esophagus, there was transillumination in two cadavers. One showed a bright, elongated lateral glow at the level of cricoid cartilage; the other a pattern mimicking that from the right piriform sinus. Light-guided intubation would result in variable, but predictable glows at the anterior neck, except for ETT-TL tip inside the glottic opening. A bright, round or oval glow in the midline just below the cricothyroid junction could be a reliable pattern to indicate the ETT-TL tip has passed the vocal cords.
中文摘要................................I
英文摘要................................III
目錄..................................V
壹、緒言
重要性...............................1
背景知識
一、氣管插管的適應症.......................2
二、氣管插管的執行........................2
三、氣管插管的困難度.......................2
四、執行氣管插管的其他替代性技術.................3
五、以燈杖行氣管插管所使用的原理.................3
六、燈杖的演化及TrachlightTM的發明................4
七、研究目的...........................6
貳、實驗對象與方法
一、實驗對象...........................7
二、實驗執行步驟.........................7
三、實驗分析方式.........................8
參、實驗結果
一、聲門內的燈杖在前頸區的透照形態................10
二、中線上在聲門上方的燈杖在前頸區的透照形態...........10
三、兩側梨狀竇的燈杖在前頸區的透照形態..............11
四、食道內的燈杖在前頸區的透照形態................11
肆、討論................................12
伍、圖表與說明.............................18
陸、參考文獻..............................22
Agro F, Hung OR, Cataldo R, Carassiti M,Gherardi S (2001) Lightwand intubation using the TrachlightTM: a brief review of current knowledge. Can J Anaesth 48:592-599.
Ainsworth QP, Howells TH (1989) Transilluminated tracheal intubation. Br J Anaesth 62:494-497.
Davis L, Cook-Sather SD, Schreiner MS (2000) Lighted stylet tracheal intubation. Anesth Analg 90:745-756.
Ellis GE, Jakymec A, Kaplan RM, Stewart RD, Freeman JA, Bleyaert A, Berkebile PE (1986) Guided orotracheal intubation in the operating room using a lighted stylet: a comparison with direct laryngoscopic technique. Anesthesiology 64:823-826.
Graham DH, Doll WA, Robinson AD, Warriner CB (1991) Intubation with lighted stylet. Can J Anaesth 38:261-262.
Hung OR, Pytka S, Morris I, Murphy M, Launcelott G, Stevens S, MacKay W, Stewart RD (1995a) Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology 83:509-514.
Hung OR, Stewart RD (1995b) Lightwand intubation: I - A new lightwand device. Can J Anaesth 42:820-825.
Stewart RD, LaRosee A, Kaplan RM, Ilkhanipour K (1990) Correct positioning of an endotracheal tube using a flexible lighted stylet. Crit Care Med 18:97-99.
Vollmer TP, Stewart RD, Paris PM, Ellis D, Berkebile PE (1985) Use of a lighted stylet for guided orotracheal intubation in the prehospital settiing. Ann Emerg Med 14:324-328.
Weis FR, Hatton MN (1989) Intubation by use of the light wand: experience in 253 patients. J Oral Maxillofac Surg 47:560-577.
Yamamura H, Yamamoto T, Kamiyamama M (1959) Device for blind nasal intubation. Anesthesiology 20:221.
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