肿瘤累及颈段气管患者的术前气道处理及围手术期窒息预防

发布时间：2018-05-05 01:23

本文选题：气管切开术 + 麻醉　；参考：《临床耳鼻咽喉头颈外科杂志》2017年23期

【摘要】：目的:探讨肿瘤累及颈段气管患者术前气道处理及术后窒息预防措施,为手术的安全性提供临床依据。方法:回顾性分析35例不同程度的肿瘤累及颈段气管患者的临床资料,根据患者就诊时是否强迫体位、呼吸困难程度、复发肿瘤范围等情况,选择常规气管插管后麻醉、表面麻醉后清醒状态下可视喉镜辅助下插管麻醉、术前气管切开插管麻醉、横断气管插管麻醉以及体外循环技术的麻醉方法。术后根据手术中气管受累程度和处理方式以及患者的全身状况选择气管切开或造瘘。结果:35例患者均成功实施全身麻醉,其中17例术前无强迫体位及呼吸困难的患者均顺利麻醉插管;术后3例进行了预防性气管切开。16例伴有强迫体位的非复发肿瘤患者中,15例术前均先吸入表面麻醉后在清醒状态下经可视喉镜辅助成功行麻醉插管,1例无法麻醉插管也无法急诊气管切开的患者利用体外循环技术完成麻醉;本组患者术后均行预防性气管切开或造瘘。2例伴有强迫体位的复发肿瘤患者,术前气管插管未能成功,1例紧急横断气管再麻醉插管,1例术前紧急气管切开插管麻醉成功,2例均术后气管造瘘。所有患者术后均未出现大出血、窒息、心血管意外等严重并发症。结论:肿瘤累及颈段气管患者术前气道处理及术后是否行气管切开或造瘘预防窒息需根据累及颈段气管肿瘤的性质、是否为复发肿瘤、气管受累及的程度以及是否合并OSAHS来决定。只有综合考虑影响气道的各种因素,采取有效的方法,才能保证手术的安全性。
[Abstract]:Objective: to investigate the preoperative airway management and postoperative asphyxia prevention in patients with cervical trachea involvement. Methods: the clinical data of 35 patients with different degrees of tumor involved in cervical trachea were retrospectively analyzed. Routine anesthesia after tracheal intubation was selected according to whether the patient was forced to sit, the degree of dyspnea, the extent of recurrence of tumor, and so on. Visual laryngoscope assisted intubation anesthesia, preoperative tracheotomy and intubation anesthesia, transverse tracheal intubation anesthesia and cardiopulmonary bypass anesthesia. Tracheotomy or fistula was selected according to the degree of trachea involvement and the management of the patients. Results General anesthesia was performed successfully in 35 patients, 17 of them had no obsessive-compulsive posture and dyspnea before operation. Postoperative 3 cases underwent prophylactic tracheotomy. 16 cases of non-recurrent tumor patients with forced posture. 15 cases were all inhaled surface anesthesia before operation, and 1 case could not be anesthetized by intubation under visual laryngoscope in awake state. Intubation can not be emergency tracheotomy patients using cardiopulmonary bypass technology to complete anesthesia; All the patients underwent prophylactic tracheotomy or fistula. 2 patients with recurrent tumor in forced posture. Preoperative trachea intubation failed to succeed in 1 case of emergency transection tracheal intubation and 1 case of emergency tracheotomy and intubation anesthesia were successful in 2 cases after tracheostomy. No severe complications such as massive bleeding, asphyxia and cardiovascular accidents were found in all patients. Conclusion: the treatment of trachea before operation and the prevention of asphyxia after tracheotomy or ostomy in patients with cervical trachea involvement should be based on the nature of the tumor involved in the cervical trachea and whether it is a recurrent tumor. The extent to which the trachea is involved and whether it is combined with OSAHS is determined. The safety of the operation can be ensured only by considering all kinds of factors affecting the airway and adopting effective methods.
【作者单位】：安徽医科大学第一附属医院耳鼻咽喉头颈外科;
【基金】：安徽省2015科技攻关计划项目(No:1501041147)
【分类号】：R614;R736.1

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