本文選題：氣管切開術(shù) + 麻醉　； 參考：《臨床耳鼻咽喉頭頸外科雜志》2017年23期

【摘要】：目的:探討腫瘤累及頸段氣管患者術(shù)前氣道處理及術(shù)后窒息預(yù)防措施,為手術(shù)的安全性提供臨床依據(jù)。方法:回顧性分析35例不同程度的腫瘤累及頸段氣管患者的臨床資料,根據(jù)患者就診時是否強迫體位、呼吸困難程度、復(fù)發(fā)腫瘤范圍等情況,選擇常規(guī)氣管插管后麻醉、表面麻醉后清醒狀態(tài)下可視喉鏡輔助下插管麻醉、術(shù)前氣管切開插管麻醉、橫斷氣管插管麻醉以及體外循環(huán)技術(shù)的麻醉方法。術(shù)后根據(jù)手術(shù)中氣管受累程度和處理方式以及患者的全身狀況選擇氣管切開或造瘺。結(jié)果:35例患者均成功實施全身麻醉,其中17例術(shù)前無強迫體位及呼吸困難的患者均順利麻醉插管;術(shù)后3例進行了預(yù)防性氣管切開。16例伴有強迫體位的非復(fù)發(fā)腫瘤患者中,15例術(shù)前均先吸入表面麻醉后在清醒狀態(tài)下經(jīng)可視喉鏡輔助成功行麻醉插管,1例無法麻醉插管也無法急診氣管切開的患者利用體外循環(huán)技術(shù)完成麻醉;本組患者術(shù)后均行預(yù)防性氣管切開或造瘺。2例伴有強迫體位的復(fù)發(fā)腫瘤患者,術(shù)前氣管插管未能成功,1例緊急橫斷氣管再麻醉插管,1例術(shù)前緊急氣管切開插管麻醉成功,2例均術(shù)后氣管造瘺。所有患者術(shù)后均未出現(xiàn)大出血、窒息、心血管意外等嚴重并發(fā)癥。結(jié)論:腫瘤累及頸段氣管患者術(shù)前氣道處理及術(shù)后是否行氣管切開或造瘺預(yù)防窒息需根據(jù)累及頸段氣管腫瘤的性質(zhì)、是否為復(fù)發(fā)腫瘤、氣管受累及的程度以及是否合并OSAHS來決定。只有綜合考慮影響氣道的各種因素,采取有效的方法,才能保證手術(shù)的安全性。
[Abstract]:Objective: to investigate the preoperative airway management and postoperative asphyxia prevention in patients with cervical trachea involvement. Methods: the clinical data of 35 patients with different degrees of tumor involved in cervical trachea were retrospectively analyzed. Routine anesthesia after tracheal intubation was selected according to whether the patient was forced to sit, the degree of dyspnea, the extent of recurrence of tumor, and so on. Visual laryngoscope assisted intubation anesthesia, preoperative tracheotomy and intubation anesthesia, transverse tracheal intubation anesthesia and cardiopulmonary bypass anesthesia. Tracheotomy or fistula was selected according to the degree of trachea involvement and the management of the patients. Results General anesthesia was performed successfully in 35 patients, 17 of them had no obsessive-compulsive posture and dyspnea before operation. Postoperative 3 cases underwent prophylactic tracheotomy. 16 cases of non-recurrent tumor patients with forced posture. 15 cases were all inhaled surface anesthesia before operation, and 1 case could not be anesthetized by intubation under visual laryngoscope in awake state. Intubation can not be emergency tracheotomy patients using cardiopulmonary bypass technology to complete anesthesia; All the patients underwent prophylactic tracheotomy or fistula. 2 patients with recurrent tumor in forced posture. Preoperative trachea intubation failed to succeed in 1 case of emergency transection tracheal intubation and 1 case of emergency tracheotomy and intubation anesthesia were successful in 2 cases after tracheostomy. No severe complications such as massive bleeding, asphyxia and cardiovascular accidents were found in all patients. Conclusion: the treatment of trachea before operation and the prevention of asphyxia after tracheotomy or ostomy in patients with cervical trachea involvement should be based on the nature of the tumor involved in the cervical trachea and whether it is a recurrent tumor. The extent to which the trachea is involved and whether it is combined with OSAHS is determined. The safety of the operation can be ensured only by considering all kinds of factors affecting the airway and adopting effective methods.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院耳鼻咽喉頭頸外科;
【基金】：安徽省2015科技攻關(guān)計劃項目(No:1501041147)
【分類號】：R614;R736.1

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