主气管肿物手术的气道建立和麻醉管理  

Airway Management and Anesthesia for Tracheal Masses in 15 Patients

作　　者：高卉[1] 易杰[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730

出　　处：《中国医学科学院学报》2013年第3期322-326,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的总结主气管肿物手术建立气道的方法和麻醉管理。方法回顾性分析北京协和医院近10年主气管肿物手术15例,其中12例气管狭窄程度≥75%,有显著呼吸困难。狭窄程度≤50%的病例常规行气管插管。狭窄程度>50%的病例根据肿物所在位置选择建立气道的方式:位于上段者一律于局部麻醉下气管切开,位于下段者于肿物上方行气管插管。1例术前已有二氧化碳潴留的患者在体外循环下经纤维支气管镜引导插管至肿物下方。所有插管病例均予静脉诱导和使用骨骼肌松弛药(简称肌松药),其中气管狭窄>50%、直接插管的6例中有5例使用了超短效肌松药。结果全组患者均成功建立气道,顺利完成手术并拔管出院,无缺氧事件发生。结论气管肿物手术的气道建立方式主要取决于气管狭窄的程度、位置以及通气困难的严重程度。对于气道梗阻和呼吸窘迫严重、难以保证通气安全的病例,体外循环下实施手术是恰当的选择。Objective To summarize our experiences in anesthetic management for the resection of tracheal masses. Methods The clinical data of 15 patients with tracheal masses in Peking Union Medical College Hospital from 2002 to 2012 were analyzed retrospectively. Remarkable dyspnea and tracheal stenosis were ob- served in 12 patients. Standard orotracheal intubation was carried out in patients with less than 50% of tracheal lumen obstructed. The location of masses was critical for those with severe tracheal stenosis. Local anesthetics were applied and tracheostomy were performed in patients with masses located at the upper part of the trachea. In- tubation above the masses was established in patients with masses located at the lower part of the trachea. Percu- taneous cardiopulmonary support was introduced before anesthetic induction in a patient with severe respiratory distress and hypereapnea, then an endotracheal tube successfully passed the stenosis guided by a fiberoptic bron- choscope. General anesthesia was induced intravenously and muscle relaxants were applied in all patients. Succi- nylcholine was administrated in 5 of 6 difficult patients. Results Airway management and anesthesia were per- formed successfully in all the 15 patients. After the operations, patients were extubated and discharged from the hospital without difficulty in respiration. Conclusions The successful airway management of tracheal masses de- pends on the degree and location of stenosis and the severity of dyspnea. Extracorporeal circulation is an optimal choice for those with critical airway occlusion and adequate oxygenation can not be accomplished with conventional anesthesia.

关 键 词：主气管肿物 气道梗阻 气道管理 麻醉 体外循环 

分 类 号：R614.1[医药卫生—麻醉学]