严重气道狭窄患者气管内治疗的麻醉管理  

Anesthesia management for the trachea inteventional therapy in patients with severe airway constriction

作　　者：徐美英[1] 周宁 倪文[1] 许华[1] 李晓梅[1] 吴镜湘[1] 王芝芳[1] 李强[3] 白冲[3] 

机构地区：[1]第二军医大学附属长海医院麻醉科,上海市200433 [2]南京空军四五四医院麻醉科 [3]第二军医大学附属长海医院呼吸内科,上海市200433

出　　处：《临床麻醉学杂志》2003年第1期14-16,共3页Journal of Clinical Anesthesiology

摘　　要：目的　探讨严重气道狭窄患者气管内治疗的麻醉管理方法。方法　 10例不同原因气道狭窄患者分别进行狭窄气道内支架置入术、支架或异物取出术或气管造口处“T”管置入术 ,分别于全身麻醉下采用气管插管、喉罩及高频喷射等不同的保障气道及通气的方法。结果　经气管导管或喉罩支气管镜下定位气道内支架成功放置 7例 ;感染气管支架或异物取出失败各 1例 ,但均清除部分坏死组织 ,解除部分气道梗阻 ;经气管导管手控呼吸及高频喷射通气下“T”型硅胶管成功放置 1例。结论　严重气道狭窄患者气管内治疗的麻醉管理关键在于保障气道内操作时的气道通畅。气管插管、喉罩及高频喷射等可灵活应用于不同的病例 ,其选择主要取决于气道梗阻的部位、严重程度及治疗方法 ,医护人员的通力协作也是成功的保障之一 。Objective To discuss the anesthesia management for the trachea interventional therapy in the patients with severe airway constriction.Methods Ten patients with severe airway constriction were underwwent endotracheal stent placement,removal of stent of foreign body and 'T' cannula placement on tracheostomy under general anesthesia.The patients were ventilated via endotracheal intubation,laryngeal mask or by high frequency jet ventilation.Results The endotracheal stents were successfully placed via tracheal tube or laryngeal mask in 7 patients.Removal of infectious stent or foreign body was failed but necrotizing tissue has been removed and the airway constriction was partly relieved in another two cases.One patient underwent 'T' cannula placement under endotracheal intubation with manual controlled ventilation and high frequency jet ventilation.Conclusion The key point of anesthesia management for the trachea interventional therapy in the patients with severe airway constriction is to keep the airway patent.Endotracheal intubation,laryngeal mask and high frequency jet ventilation can be flexiblely used according to the position and severity of airway constriction and the therapy method.A well co operation of all the staffs is one of the successful guarenties.Ventilation via laryngeal mask is one of the choices in airway management. [

关 键 词：气道狭窄 气管内治疗 麻醉管理 

分 类 号：R614[医药卫生—麻醉学]