声门下气管狭窄患者Montgomery T管植入术的麻醉管理  

Anaesthetic management of montgomery T-tube insertion for subglottic stenosis

作　　者：岳红丽[1] 王娟[2] 裴迎华[2] 张晨阳[2] 徐敏 Yue Hongli;Wang Juan;Pei Yinghua;Zhang Chenyang;Xu Min(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Respiratory Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100070 [2]首都医科大学附属北京天坛医院呼吸内科,100070

出　　处：《国际呼吸杂志》2020年第6期450-454,共5页International Journal of Respiration

摘　　要：目的:探讨声门下气管狭窄患者行Montgomery T管植入术的麻醉管理。方法:回顾并分析20例因"声门下气管狭窄"行Montgomery T管植入术患者的一般情况、临床特征、麻醉方法、手术操作及术后恢复等资料。结果:狭窄原因:气管插管12例,颈部气管外伤4例,气管内外肿瘤等3例。狭窄程度:Myer-Cotton分级Ⅰ级1例,Ⅱ级3例,Ⅲ级9例,Ⅳ级7例;9例患者术前气管镜检查显示气管塌陷。所有病例术前行气管切开,术中经硬镜操作,采用全凭静脉麻醉,麻醉过程平稳,麻醉通气方式转换顺利。术后出现咳嗽(80%)、咽痛(45%)、发热(45%)、排痰困难(40%)、呼吸困难(25%)、感染(10%)、气道梗阻(5%)和误吸(5%)等并发症,经积极处理均可改善。结论:声门下气道狭窄行Montgomery T管植入术时,全凭静脉麻醉能够维持稳定的麻醉深度和循环;根据手术步骤转换气管切开管、T管、喉罩控制通气或高频通气可保证氧气供应;围术期密切沟通、积极处理术后并发症有利于手术安全和患者康复。Objective To discuss the anaesthetic management of Montgomery T-tube insertion for subglottic stenosis.Methods The data including characteristics,clinical features,anaesthetic methods,operation procedures and postoperative recovery of 20 patients with subglottic stenosis underwent Montgomery T-tube insertion were reviewed and analyzed.Results The causes of stenosis were tracheal intubation(12 cases),tracheal trauma(four cases),internal and external tracheal tumors(three cases).On the degree of stenosis,there was one case of Myer-Cotton gradeⅠ,three cases of gradeⅡ,nine cases of gradeⅢ,seven cases of gradeⅣ.Bronchoscopic examination showed tracheal collapse in nine cases.All patients were tracheotomized before operation and used a rigid bronchoscope as working channel during operation.All patients were anaesthetized with total intravenous anaesthesia.The anaesthesia of all patients was stable,and ventilation modes were alternated smoothly.Postoperative complications such as cough(80%),sore throat(45%),fever(45%),difficulty in sputum evacuation(40%),difficulty breathing(25%),infection(10%),airway obstruction(5%),aspiration(5%)were cured after active treatment.Conclusions During montgomery T-tube insertion for subglottic stenosis,total intravenous anaesthesia can ensure depth of anaesthesia and stability of circulatory parameters.Controlled ventilation or high frequency ventilation by tracheotomy tube,T-tube,and laryngeal mask on demand can ensure oxygen supply.Communication closely during perioperation and active treatment of postoperative complications are beneficial for the safety and the recovery of patients.

关 键 词：获得性声门下气管狭窄 气管T管 麻醉 

分 类 号：R614[医药卫生—麻醉学]