气管病变的气管内麻醉管理

发布时间：2018-06-17 19:53

本文选题：气管内麻醉 + 气道病变　；参考：《山东大学》2014年硕士论文

【摘要】：目的探讨气管病变患者气管内麻醉的常见和罕见问题,并提出对策；讨论可视技术在气管病变麻醉的意义及注意事项。方法山东大学第二医院2013年1月到12月的气管病变需要气管内麻醉患者15例,其中气管支架后需要气管插管的患者6例,瘢痕性气管狭窄患者2例,气管内肿瘤5例,气管外伤2例。清醒气管插管3例,快速诱导气管插管10例,气管切开2例。所有患者都在可视喉镜引导下,把套有气管插管的纤支镜插入气管,气管插管进入声门。在纤支镜引导下13例完成气管插管,1例气管狭窄患者气管切开,1例气管断裂患者改由快速气管切开插管成功。结果13例患者顺利完成气管内插管麻醉,其中1例气管断裂患者发生纤支镜引导下气管插管困难,快速气管切开插管成功,1例气管狭窄患者气管切开。2例气管支架后需要气管插管的患者,拔管时发生气管支架移位,需要在纤支镜引导下重新调整气管支架位置。结论术前认真访视病人,针对性制定个性化麻醉方案,熟练应用纤维支气管镜和可视喉镜技术,是气管病变的气管内麻醉成功的关键。
[Abstract]:Objective to discuss the common and rare problems of trachea anesthesia in patients with tracheal diseases, and to discuss the significance of visual technique in trachea anesthesia. Methods from January to December 2013, 15 patients with trachea diseases needed endotracheal anesthesia, including 6 patients with tracheal stents, 2 patients with scar tracheal stenosis and 5 patients with intratracheal tumors. There were 2 cases of trachea trauma. Conscious tracheal intubation in 3 cases, rapid induction of endotracheal intubation in 10 cases, tracheotomy in 2 cases. All patients were guided by visual laryngoscope to insert a fiberoptic bronchoscope with tracheal intubation into the glottis. Under the guidance of fiberoptic bronchoscope, 13 patients with trachea intubation and 1 patient with trachea stenosis underwent tracheotomy. One patient with trachea rupture was successfully intubated by rapid tracheotomy. Results 13 patients successfully completed endotracheal intubation anesthesia, and one patient with tracheal rupture suffered from tracheal intubation difficulties under fiberoptic bronchoscopy. Rapid tracheotomy and intubation was successful in 1 patient with trachea stenosis. After tracheotomy, 2 patients needed tracheal stent intubation. Tracheal stent displacement occurred during extubation, and the tracheal stent position should be readjusted under the guidance of fiberoptic bronchoscope. Conclusion the key to success of tracheal anesthesia is to visit patients carefully before operation, to draw up individualized anaesthesia plan and to apply fiberoptic bronchoscopy and visual laryngoscope skillfully.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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