局部麻醉和通气导管辅助下气管支架置入术治疗恶性气管狭窄  

Ventilatory catheter-assisted airway stenting under local anesthesia for patients with malignant airway stenosis

作　　者：魏宁[1] 傅宇飞[1] 徐浩[1] 祖茂衡[1] 王文亮[1] 肖晋昌[1] 王洵[1] 

机构地区：[1]徐州医学院附属医院介入放射科,221006

出　　处：《中华放射学杂志》2014年第11期930-933,共4页Chinese Journal of Radiology

基　　金：江苏省临床医学科技专项（BL2013011）;江苏省徐州医学院“振兴计划”（XZMC2012-2015）

摘　　要：目的 探讨在局部麻醉和通气导管辅助下气管支架置入术的可行性与安全性.方法 回顾性分析2008年9月至2013年11月,25例恶性气管狭窄患者行局部麻醉和通气导管辅助下气管支架置入术的情况.25例患者气促评级为2-4级,其中2级3例、3级18例、4级4例.治疗过程中,预先将1根4F单弯导管通过气管狭窄段置入一侧主支气管作为通气导管,根据患者的病情设氧流量为2-4 L/min,然后在维持通气的状态下予以置入气管支架,支架释放后再撤出通气导管.术后统计并分析气管支架置入技术成功率、患者症状缓解情况及随访的相关数据.术前与术后患者的血氧饱和度（SaO2）及呼吸频率的变化情况采用配对t检验.结果 在局部麻醉和通气导管辅助下气管支架置入术均获得成功,共置入气管支架25枚,其中筒状支架19枚、Y型支架6枚.置入通气导管通气后,所有患者的SaO2迅速提升至94％-97％,当气管支架输送器通过气管狭窄段时,所有患者SaO2仍可维持在92％-97％,均无呼吸困难,支架释放顺利.术后25例患者症状均得到改善,气促评级术后O级2例、1级19例、2级4例,呼吸频率及SaO2由术前的（30.0±2.1）次/min与（76.0±3.8）％改善至术后的（19.7±1.6）次/min（t=23.33,P＜0.01）与（93.0±1.7）％（t=23.50,P＜0.01）,差异均有统计学意义.术后随访2-11个月,3例患者出现了支架相关并发症,其中支架断裂1例、支架再狭窄2例.结论 局部麻醉下通气导管辅助下气管支架置入术是一种安全、简便并且有效的方法,值得临床推广.Objective To discuss the ventilatory catheter-assisted airway stenting under local anesthesia for airway stenosis.Methods From May 2008 to January 2013,25 consecutive patients with airway stenosis underwent the treatment of ventilatory catheter-assisted airway stenting under local anesthesia.The dyspnea score was grade Ⅱ in 3 patients,grade Ⅲ in 18 patients and grade Ⅳ in 4 patients.During the treatment,a 4 F VER catheter was placed into one of the main bronchi as a ventilatory catheter for oxygen supply in advance,the oxygen flow was set at 2 to 4 L/rmin according to the patients＇ condition,then the airway stenting was performed,after release of the stent,the ventilatory catheter was removed smoothly.Data on technical success,clinical outcome and follow-up were collected and analyzed respectively.The paired t test was performed to compare variables before and after tracheal stenting.Results Ventilatory catheter-assisted airway stenting under local anesthesia was technically successful in all patients.A total of 25 stents were placed in 25 patients.The stents included I-shaped stents （n=19） and Y-shaped stents （n=6）.After the oxygen supply,the patients＇ SaO2 was increased to 94% to 97% rapidly.When the stent introducer sheaths were passing through the stenotic site,the SaO2 could be maintained at 92% to 97%.The improvement of the respiratory difficulty was achieved in 100% of our patients.The hypoxia symptom was relieved immediately after stents placement,the dyspnea score decreased to grade 0 in 2 patients,to grade Ⅰ in 19 patients and to grade Ⅱ in 4 patients.Respiratory rate and SaO2 improved from （30.0±2.1） times/min and （6.0±3.8）% before stenting to （19.7±1.6） times/min （t=23.33,P〈0.01） and （93.0± 1.7）% （t=23.50,P〈0.01） after stenting,respectively.Through the follow-up,3 patients suffered the stent-related complications after discharge,the complications included re-stenosis （n=2） and fracture（n=1）.Conclusion Ventilatory catheter-assisted airway st

关 键 词：气管狭窄 麻醉 局部 支架 

分 类 号：R614[医药卫生—麻醉学]