经口寰枢椎复位钢板内固定术后经鼻气管导管拔除的指针和方法  

The indications and methods of nasotracheal extubation in patients undergoing transoral atlantoaxial reduction plate internal fixation surgery

作　　者：戴建强[1] 尹庆水[1] 夏虹[1] 郑国栋[1] 张亮达[1] 黄显华[1] 

机构地区：[1]广州军区广州总医院骨科重症监护病房,广东广州510010

出　　处：《临床骨科杂志》2015年第3期276-279,共4页Journal of Clinical Orthopaedics

基　　金：全军医学科研"十二五"计划第一批重点课题(编号:BSW11C065)

摘　　要：目的探讨经口寰枢椎复位钢板（TARP）内固定术后经鼻气管导管拔除的指针和方法。方法 187例行TARP内固定手术成年患者,术前均经鼻腔放置加强型气管导管,术毕留置气管导管并口腔填塞纱条压迫止血。术后第1天起每日进行拔管指针评估,在神志清楚、咳嗽能力及呼吸循环功能正常、伤口无裂开出血前提下,依据气囊漏气试验（CLT）指导拔管,CLT阴性者即行常规拔管。若术后第3天CLT仍阳性则在纤维支气管镜辅助下（FBA）试拔管。记录拔管后喘鸣和24 h内再插管率,分析该拔管方法的优点和安全性。结果术后第1、2天常规拔管者分别为69、82例。第3天常规拔管15例,其余21例采用FBA试拔管,其中11例拔管成功,10例试拔管后出现喘鸣和呼吸困难而留管至第4天。第4天6例常规拔管,4例FBA拔管成功。第1~4天常规拔管者中喘鸣发生例数分别为4、6、1、1例（共12例）,其中1例于拔管后4 h被迫再次插管。FBA拔管成功者中没有出现拔管后喘鸣和需再插管。结论严格掌握拔管指针和拔管方法,TARP内固定术后患者大多能在术后2 d内顺利拔除气管导管。CLT结合FBA拔管安全有效,能避免拔管后24 h内再插管的发生。Objective To explore the indications and methods of nasotracheal extubation in patients undergoing transoral atlantoaxial reduction plate（ TARP） internal fixation surgery. Methods One hundred and eighty seven adult patients scheduled for TARP internal fixation surgery were enrolled in this prospective study. All patients were nasotracheal intubated preoperatively. Nasotracheal tube（ NTT） was kept and oral cavity was filled with gauze for hemostasis postoperatively. Since the first postoperative day,each patient was evaluated daily whether NTT could be extubated. Under the precondition of that consciousness,expectoration capacity,respiratory and circulatory function were normal,and pharyngeal wound dehiscence or hemorrhage were not noticed,readiness for extubation was based on the qualitative cuff-leak test（ CLT）,and NTT was extubated routinely in patients with negative CLT. From the third day after surgery,extubation with fiber bronchoscope assistance（ FBA） was attempted in patients with positive CLT. After extubation,stridor and reintubation within 24 hours were recorded and analyzed. Results 69 cases,82 cases were extubated routinely on the first,second postoperative day respectively. On the third day after surgery,fifteen patients were extubated routinely and eleven patients were extubated successfully with FBA and ten patients were kept intubated for emergence of stridor and dyspnea during the extubation with FBA. On the fourth postoperative day,six patients were extubated routinely and four patients were extubated successfully with FBA. Among the patients that could be extubated routinely,4 patients,6 patients,1 patient and 1 patient developed stridor on the first,second,third and fourth postoperative day,respectively,and 1 patient needed reintubation at 4h after extubation. No stridor and reintubations occurred in patients extubated successfully with FBA. Conclusions Provided indications and methods for extubation are executed strictly,most NTT can be extubated safely in patients undergoing

关 键 词：经口寰枢椎复位钢板内固定术 经鼻气管导管 拔管 气囊漏气试验 纤维支气管镜辅助 

分 类 号：R687.3[医药卫生—骨科学] R619[医药卫生—外科学]