本文選題：纖維支氣管鏡 + 經(jīng)鼻��； 參考：《中國農(nóng)村衛(wèi)生》2016年24期

【摘要】：目的:探討纖維支氣管鏡(fibreoptic bronchoscope,FOB)引導(dǎo)下經(jīng)鼻清醒氣管插管術(shù)在頜面外科手術(shù)中的臨床運(yùn)用。方法:45例頜面外傷患者其中多發(fā)下頜骨骨折18例,上頜骨及顴骨骨折15例,上下頜骨多發(fā)骨折且合并有四肢骨折者12例,男38例,女7例,年齡16~38歲。方法術(shù)前30 min給東莨菪堿0.3 mg肌注。分段實(shí)施局部麻醉:鼻腔以1%丁卡因加3%麻黃堿行鼻腔表面麻醉并使鼻腔黏膜血管收縮;喉聲門上區(qū)喉上神經(jīng)阻滯(SLNB)以2%利多卡因經(jīng)舌骨大角前下穿刺行SLNB,左右各2 ml;喉聲門下區(qū)以2%利多卡因2 ml/次經(jīng)環(huán)甲膜穿刺行喉及氣管表面麻醉。適度鎮(zhèn)靜局部麻醉完善后,給咪迭唑侖1~2 mg+芬太尼0.02~0.04 mg靜脈滴注。經(jīng)鼻腔置入纖支鏡和引導(dǎo)插入氣管導(dǎo)管由助手扶持患者頭部于合適位置,操作者位于患者頭部,將套有鋼絲氣管導(dǎo)管(ID6~7 mm)的纖支鏡經(jīng)鼻腔置入,出后鼻孔后即可見會(huì)厭,緩慢推進(jìn)纖支鏡并調(diào)整角度完全暴露聲門,將纖支鏡頭端進(jìn)入聲門下氣管內(nèi)3~5 cm,看到氣管隆突后即可順勢(shì)導(dǎo)入氣管導(dǎo)管,退出纖支鏡固定導(dǎo)管。結(jié)果:全部45例插管均一次成功,耗時(shí)0.5~1.5 min。有4例在導(dǎo)管出后鼻孔后有不適感,另有6例插管后輕微嗆咳,但均未出現(xiàn)嚴(yán)重并發(fā)癥。結(jié)論:頜面外傷患者多伴領(lǐng)面部嚴(yán)重挫裂傷及多發(fā)骨折,麻醉處理較為棘手。纖維支氣管鏡引導(dǎo)下經(jīng)鼻清醒氣管插管具有快速準(zhǔn)確安全、成功率高、損傷小、并發(fā)癥少的優(yōu)點(diǎn),且可通過纖支鏡清理呼吸道分泌物、血液及給氧,在有條件的單位不失為處理此類氣道的好方法。
[Abstract]:Objective: to investigate the clinical application of fibreoptic bronchoscope guided tracheal intubation in maxillofacial surgery. Methods among 45 patients with maxillofacial trauma, 18 had multiple mandibular fractures, 15 had maxillary and zygomatic fractures, 12 had multiple maxillary and mandibular fractures with limb fractures, 38 were males and 7 were females, aged 1638 years. Methods Scopolamine 0.3 mg was injected intramuscularly 30 min before operation. Segmental local anesthesia: nasal surface anesthesia was performed with 1% tetracaine and 3% ephedrine and the nasal mucosal blood vessels were constricted. The superior laryngeal nerve block (SLNB) in the supraglottic area was performed with 2% lidocaine through the anterior inferior hyoid, 2 ml on the left and right, and 2 ml/ on the laryngeal and tracheal surface at the subglottic area with 2% lidocaine. After moderate sedation local anesthesia was completed, midazolam was injected intravenously with 1.2 mg fentanyl 0.02 mg fentanyl 0.04 mg. A fiberoptic bronchoscope was inserted through the nasal cavity and a tracheal catheter was inserted into the nasal cavity. The assistant supported the patient's head in a suitable position. The operator was located in the patient's head. A fiberoptic bronchoscope with a steel wire tracheal catheter (ID _ (6) was inserted through the nasal cavity, and epiglottis could be seen immediately after the exit of the posterior nostril. Slowly advancing the fiberoptic bronchoscope and adjusting the angle to expose the glottis completely, the fiberoptic lens end was put into the subglottic trachea for 35 cm, and the trachea protuberance could be introduced into the tracheal tube homeologically, and the fiberoptic bronchoscope could be used to fix the catheter. Results: all 45 cases were successfully intubated at a time of 0.5 ~ 1.5 min. There were 4 cases of discomfort after catheterization, 6 cases of mild cough after intubation, but no serious complications. Conclusion: patients with maxillofacial trauma are often accompanied by severe contusion and multiple fractures. Fiberoptic bronchoscope guided tracheal intubation has the advantages of rapid, accurate, safe, high success rate, small injury, less complications, and can be used to clean up respiratory tract secretions, blood and oxygen supply through fiberoptic bronchoscope. A conditional unit is a good way to handle such airways.
【作者單位】： 山東省榮成市石島人民醫(yī)院;
【分類號(hào)】：R614

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