纤维支气管镜引导经鼻清醒气管插管在颌面外科手术中的临床应用

发布时间：2018-07-04 21:06

本文选题：纤维支气管镜 + 经鼻　；参考：《中国农村卫生》2016年24期

【摘要】：目的:探讨纤维支气管镜(fibreoptic bronchoscope,FOB)引导下经鼻清醒气管插管术在颌面外科手术中的临床运用。方法:45例颌面外伤患者其中多发下颌骨骨折18例,上颌骨及颧骨骨折15例,上下颌骨多发骨折且合并有四肢骨折者12例,男38例,女7例,年龄16~38岁。方法术前30 min给东莨菪碱0.3 mg肌注。分段实施局部麻醉:鼻腔以1%丁卡因加3%麻黄碱行鼻腔表面麻醉并使鼻腔黏膜血管收缩;喉声门上区喉上神经阻滞(SLNB)以2%利多卡因经舌骨大角前下穿刺行SLNB,左右各2 ml;喉声门下区以2%利多卡因2 ml/次经环甲膜穿刺行喉及气管表面麻醉。适度镇静局部麻醉完善后,给咪迭唑仑1~2 mg+芬太尼0.02~0.04 mg静脉滴注。经鼻腔置入纤支镜和引导插入气管导管由助手扶持患者头部于合适位置,操作者位于患者头部,将套有钢丝气管导管(ID6~7 mm)的纤支镜经鼻腔置入,出后鼻孔后即可见会厌,缓慢推进纤支镜并调整角度完全暴露声门,将纤支镜头端进入声门下气管内3~5 cm,看到气管隆突后即可顺势导入气管导管,退出纤支镜固定导管。结果:全部45例插管均一次成功,耗时0.5~1.5 min。有4例在导管出后鼻孔后有不适感,另有6例插管后轻微呛咳,但均未出现严重并发症。结论:颌面外伤患者多伴领面部严重挫裂伤及多发骨折,麻醉处理较为棘手。纤维支气管镜引导下经鼻清醒气管插管具有快速准确安全、成功率高、损伤小、并发症少的优点,且可通过纤支镜清理呼吸道分泌物、血液及给氧,在有条件的单位不失为处理此类气道的好方法。
[Abstract]:Objective: to investigate the clinical application of fibreoptic bronchoscope guided tracheal intubation in maxillofacial surgery. Methods among 45 patients with maxillofacial trauma, 18 had multiple mandibular fractures, 15 had maxillary and zygomatic fractures, 12 had multiple maxillary and mandibular fractures with limb fractures, 38 were males and 7 were females, aged 1638 years. Methods Scopolamine 0.3 mg was injected intramuscularly 30 min before operation. Segmental local anesthesia: nasal surface anesthesia was performed with 1% tetracaine and 3% ephedrine and the nasal mucosal blood vessels were constricted. The superior laryngeal nerve block (SLNB) in the supraglottic area was performed with 2% lidocaine through the anterior inferior hyoid, 2 ml on the left and right, and 2 ml/ on the laryngeal and tracheal surface at the subglottic area with 2% lidocaine. After moderate sedation local anesthesia was completed, midazolam was injected intravenously with 1.2 mg fentanyl 0.02 mg fentanyl 0.04 mg. A fiberoptic bronchoscope was inserted through the nasal cavity and a tracheal catheter was inserted into the nasal cavity. The assistant supported the patient's head in a suitable position. The operator was located in the patient's head. A fiberoptic bronchoscope with a steel wire tracheal catheter (ID _ (6) was inserted through the nasal cavity, and epiglottis could be seen immediately after the exit of the posterior nostril. Slowly advancing the fiberoptic bronchoscope and adjusting the angle to expose the glottis completely, the fiberoptic lens end was put into the subglottic trachea for 35 cm, and the trachea protuberance could be introduced into the tracheal tube homeologically, and the fiberoptic bronchoscope could be used to fix the catheter. Results: all 45 cases were successfully intubated at a time of 0.5 ~ 1.5 min. There were 4 cases of discomfort after catheterization, 6 cases of mild cough after intubation, but no serious complications. Conclusion: patients with maxillofacial trauma are often accompanied by severe contusion and multiple fractures. Fiberoptic bronchoscope guided tracheal intubation has the advantages of rapid, accurate, safe, high success rate, small injury, less complications, and can be used to clean up respiratory tract secretions, blood and oxygen supply through fiberoptic bronchoscope. A conditional unit is a good way to handle such airways.
【作者单位】：山东省荣成市石岛人民医院;
【分类号】：R614

【相似文献】