周围体外循环在气管插管困难手术中的应用

摘要

目的：探讨周围体外循环在气管插管困难手术中应用的可行性和适应证，总结应用中的经验教训。方法收集8例气管插管困难患者，其中气管肿瘤5例，气管内肉芽肿1例，巨大甲状腺肿2例。均予以周围体外循环辅助，于术前局麻下股动脉、股静脉插管建立体外循环，切除肿瘤或处理完气管病变后，气管插管可通过狭窄段，重建气管通路后停止转流。结果体外循环转流时间（58．00±17．34）min；体外循环转流过程中脑氧饱和度最低值68．25％±4．49％，全部在正常范围；体外循环停机均顺利，并安全完成手术；全部患者随访3个月，无1例死亡，未发生体外循环相关并发症。结论周围体外循环技术可提供安全可行的呼吸循环辅助方式，利于各种原因造成的气管插管困难患者安全顺利完成手术。%Objective To explore the feasibility and indications of the application of peripheral cardiopulmonary bypass in patients with difficult tracheal intubation,and to summarize the experience and lessons in the application.Methods A total of 8 cases with difficult tracheal intubation was collected,male 4 cases,female 2 cases.There were 5 cases of tracheal tumor,1 case of tracheal granuloma,and 2 cases of huge goiter.In preoperative anesthesia femoral artery and femoral vein intubation cardiopulmonary bypass was established.Af-ter the resection of tumor or dealing with tracheal lesions,tracheal intubation can be through the stricture and stop bypass after recon-struction of tracheal pathway.Results Cardiopulmonary bypass flow time was (58.00 ±17.34)min;the lowest values of cerebral oxy-gen saturation during the cardiopulmonary bypass process (68.25 ±4.49)% were all within the normal range.extracorporeal circula-tion stopped smoothly,and the operation was successful.All the cases were followed up for 3 months.There was no death or cardiopul-monary bypass related complication.Conclusions Peripheral extracorporeal circulation technique can be used to provide a safe and feasible method to aid cardiopulmonary circulation for the patients with difficult tracheal intubation.