全身麻醉下气管支架置入治疗恶性气道狭窄  

Metallic stent implantation in the treatment of malignant tracheal stenosis under general anaesthesia

作　　者：白旭明[1] 靳勇[1] 谢红[2] 程龙[1] 顾星石[1] 常留辉[2] 

机构地区：[1]苏州大学附属第二医院介入科,215004 [2]苏州大学附属第二医院麻醉科,215004

出　　处：《中华放射学杂志》2012年第4期354-358,共5页Chinese Journal of Radiology

摘　　要：目的探讨全身麻醉下气管内支架置入术治疗恶性气管、主支气管狭窄的可行性和安全性。方法18例恶性肿瘤引起的气管、主支气管狭窄患者（气管腺癌1例、食管癌9例、肺癌纵隔淋巴结转移癌7例、甲状腺癌术后纵隔内淋巴结转移1例），术前均行64排CT扫描及气道重组。其中气管狭窄5例，右支气管狭窄1例，气管合并左或右支气管狭窄7例，气管、左右支气管均狭窄5例；气管狭窄51％～70％7例，71％～90％11例。所有患者均为重度呼吸困难，根据美国麻醉师协会（ASA）评分评估Ⅳ级17例、Ⅲ级1例。患者均经全身麻醉后，在DSA监视下，经气管插管连接管的吸痰孔进入，进行气管支架置入术。手术全程监测血压、心电图、经皮血氧饱和度（SaO2）、呼吸频率。术后观察患者呼吸困难缓解情况，麻醉及手术相关重要并发症，评价全麻效果（舒适度评分），并进行气管支架置入操作顺利度综合评价。对患者在麻醉过程不同时间的血压、心率、呼吸、SaO2以及手术前后动脉血气监测结果采用t检验进行比较。结果18例均成功置入支架，术后呼吸困难均明显缓解，7例出现轻度痰中带血、1例痰液涌出堵住支架，对症处理后好转，手术均顺利，未出现其他麻醉及手术相关严重并发症。气管支架置入操作顺利度综合评分9～11分17例，6～8分1例；手术过程中患者均配合良好；舒适度评价优16例，良2例。呼吸频率及心率在麻醉苏醒后[分别为（18．6±1．4）和（73．2±7．6）次/min]明显低于麻醉前[分别为（37．1±2．8）和（106．5±14．2）次／min]（t值分别为17．81、3．80，P值均〈0．01），SaO2在术中[（91．2±1．8）％]高于术前[（76．3±8．6）％]（t=2．06，P〈0．01）。麻醉苏醒后患者SaO2[（94．5±4．3）％]较术前明显升高（t=2．26，P〈0．01）；血压在麻醉苏醒后较麻醉前无Objective To evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk（5 patients）, in right main bronchus（ 1 patient）, in trachea and left main bronchus（4 patients）, in trachea and right main bronchus（3 patients）, in main tracheal trunk and bilateral main bronchus（5 patients）. The degree of stenosis was rated 51% to 70% in 7 cases, 71% to 90% in 11 cases. All patients, 17 patients of ASA grade Ⅳand 1 patient of grade Ⅲ, presented with severe dyspnea. Under general anaesthesia, implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance. The NBP, ECG, RR, SaO2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure, relief of dyspnea, complications related to anesthesia and operation were recorded. Results The success rate of stent placement was 18/18, and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 eases. The stent was obstructed by sputum in I case, and the patient was treated with medication. There were no severe complications. The operative course were rated 11 to 9 in 17 cases, and6 to 8 in l case. All 18 patients were cooperative during the procedure. Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable. Respiratory rate （RR） and heart rate （HR） decreased in all patients after the operation [ （ 37.1 ± 2. 8 ）/rain and （ 106. 5 ± 14. 2 ） bpm before tim operation respectively, （ 18.6 ± 1.4 ）/rain and （73.2 ± 7.6 ） bpm after the operation respectively ], t = 17. 81 and 3.80, P 〈 0. 01. Pulse oxygen saturation （ SaO2 ） during the operation [ （ 91.2 ± 1.8 ） % ] increased [ （76.

关 键 词：麻醉 全身 气管狭窄 支架 放射学 介入性 

分 类 号：R614[医药卫生—麻醉学]