巨大甲状腺肿瘤、纵膈肿瘤压迫气管患者的麻醉管理  

Anesthetic management in patients with induced tracheal compression by huge goiters or mediastinal tumors

作　　者：崔银[1] 楚帅帅 李冰冰[1] 马正良[1] 顾小萍[1] CUI Yin;CHU Shuaishuai;LI Bingbing;MA Zhengliang;GU Xiaoping(Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical Department of Nanjing University, Nanjing210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210008

出　　处：《麻醉安全与质控》2019年第2期113-115,共3页Perioperative Safety and Quality Assurance

基　　金：国家自然科学基金(81371207);南京大学中央高校基本科研业务费专项资金(021414380030)

摘　　要：巨大甲状腺肿瘤、纵膈肿瘤可压迫气管,造成呼吸困难,此类患者在麻醉手术中存在较大风险。患者术前常有呼吸短促、吞咽困难等临床表现,相关术前检查及影像学检查可明确。麻醉管理中气道管理尤需关注,麻醉诱导期镇静药及肌肉松弛药的使用可引起肌肉松弛,加重呼吸道梗阻致面罩通气困难。依据气管狭窄的位置及严重程度,需合理选择气道管理手段。完善表麻下清醒纤支镜气管插管在气管狭窄患者的手术中得到广泛应用。术中需评估肿瘤是否引起气管环的破坏及塌陷,为术后拔管的时机提供参考。巨大甲状腺肿瘤或纵膈肿瘤压迫气管患者实施麻醉仍是严峻的挑战,围术期各环节的实施包括与外科多团队配合对患者的预后至关重要。Huge goiters or mediastinal tumors can compress airway or major blood vessels, cause breathing difficulty and in consequence pose significant anesthetic risks. Patients may have symptoms of dyspnea and dysphagia. Relevant preoperative examination and imaging study can clearly assess the severity of airway compression. Airway management requires special attention. The use of sedatives and muscle relaxants during anesthesia induction may worsen airway obstruction and render bag mask ventilation difficulties. Airway management should be tailored in accordance to the location and severity of tracheal compression. Awake fiberoptic intubation with adequate local anesthetic topicalization has been widely used for narrowed airway. Airway should be further examined intraoperatively for tracheal ring collapse or destruction which provides reference on timing for extubation. Huge goiters and mediastinal tumors with airway compression can be particularly challenging, it is extremely important for patient outcomes to implement comprehensive anesthetic plans collaborating with surgical teams perioperatively.

关 键 词：巨大甲状腺肿瘤 纵膈肿瘤 麻醉 气道管理 

分 类 号：R614[医药卫生—麻醉学] R736.1[医药卫生—外科学] R734.5[医药卫生—临床医学]