三種不同材質的氣管內管在使用二氧化碳雷射手術時著火之病例報告

Fires of Endotracheal Tubes of Three Different Materials during Carbon Dioxide Laser Surgery

在二氧化碳雷射手術中常有著火的危險，因此需要用特別的氣管內管。我們追溯了七年中227個施行二氧化碳雷射喉部手術的病人。三個病人產生著火的併發症。他們分別使用三種不同的材質：矽膠製的T型管，噴射式通氣所用的管子，和Xomed牌特殊雷射防護氣管內管。另外，我們還測試在室內空氣下，持續單點照射不同材質的氣管內管著火所需的時間。從照射、著火到燒穿管壁所需的時間分別為：矽膠製的T型管為0.3秒，噴射式通氣所用管子為0.5秒，Xomed牌特殊雷射防護氣管內管為5秒，聚氯乙烯製的氣管內管0.8秒，而不鏽鋼材質作的氣管內管和包覆錫箔紙的聚氯乙烯製的氣管內管則是連續照射30秒也不會起火。因此，矽膠製的T型管最為危險。噴射式通氣所用的管子和Xomed牌特殊雷射防護氣管內管仍有起火的危險。而包覆錫箔紙的聚氯乙烯製的氣管內管也有起火的病例報告。因此，我們建議不鏽鋼材質做的氣管內管最安全。其他的材質，即使是有雷射防護措施者，仍然必須非常小心以避免著火的發生。

The hazards of fire during CO2 laser surgery of the airway necessitate the use of special endotracheal tubes. We reviewed 227 cases receiving CO2 laser laryngeal surgery over the past 7 years, of whom 3 suffered the complications as a result of endotracheal fire. Tracheal tubes made of different materials were used among them, including silicone T-tube (Montgomery Safe-T-tube), jet ventilation tube and Xomed laser shield endotracheal tube. In addition, we tested in vitro the combustibility of endotracheal tubes of six different materials which included silicone T-tube, jet ventilation tube, Xomed laser shield endotracheal tube, stainless Laser-Flex tracheal tube, polyvinyl chloride (PVC) endotracheal tube and aluminum foil wrapped PVC endotracheal tube by exposing them to continuous operating CO2 laser in room air. The time to initiation of fire and burn through the lumen was 0.3 second for T-tube, 0.5 s for jet ventilation tube, 5 s for Xomed laser shield endotracheal tube, and 0.8 s for PVC endotracheal tube, respectively. The Laser-Flex tracheal tube (stainless) and aluminum foil wrapped PVC endotracheal tube did not catch fire after 30 s of CO2 laser irradiation. The silicone T-tube seemed to be the most dangerous. Jet ventilation tube and Xomed laser shield endotracheal tube have the risk of fire. Aluminum foil wrapped PVC endotracheal tube was reported to catch fire before. Therefore we are of the opinion that the stainless endotracheal tube is the safest tube during CO2 laser surgery.