气管手术围手术期气道管理及体外循环的应用

摘要

Objective To review the methods involved in airway management of tracheal surgery and to consider the role of extracorporeal circulation.Methods A total of 91 tracheal surgeries were performed from January 2008 to February 2012,including 60 cases of tumor,8 cases of post-traumatic stenosis and 23 cases of post-tracheostomy stenosis.There were 76 male and 15 female patients,aged from 4 to 77 years.Anesthetic plans were made according to the severity and position of stenosis.Rapid sequent induction intubations were conducted on 56 patients,tracheostomy intubations on 25 patients,awake intubations on 3 patients,extracorporeal circulation on 6 patients and emergent sternotmy and tracheostomy on 1 patient.Miniature extracorporeal circulation systems were used in all extracorporeal circulation case.Results All patients discharged without major complications.There were 2 cases of massive bleeding during operations,1 case of post-operative tracheal fistula and 1 case of post-operative incision infection.All these 4 cases were treated properly and got cured.One patient on whom extracorporeal circulation was unable to set up underwent 6 minutes of hypoxia before sterotomy and tracheostomy.All the extracorporeal circulation cases were hemodynamically stable during bypass and none of them need massive transfusion.The miniature extracorporeal circulation system was convenient to use and especially suitable for tracheal surgery.Conclusions Various advanced anesthesia techniques can ensure a safe airway for most tracheal surgeries.However,extracorporeal circulation plays a major role in high risk cases.It is important to set up a miniature extracorporeal circulation circuit that is especially suitable for tracheal surgery.%目的 总结气管手术的围手术期气道管理方法以及体外循环的应用经验.方法 2008年1月至2012年2月共行气管手术91例,男性76例,女性15例,年龄4 ～ 77岁.包括肿瘤60例、外伤性狭窄8例、气管切开后狭窄23例.在术前评估中,根据气管狭窄的程度和位置制定相应的麻醉方案.56例患者行快速诱导插管,25例经气管切开处插管,3例经纤维支气管镜引导在保留自主呼吸下插管,6例行体外循环辅助,1例在建立体外循环失败及插管失败后紧急开胸手术.7例体外循环均使用微创体外循环系统.结果 所有患者安全度过围手术期,无住院死亡及重要器官系统并发症.2例患者发生术中大量出血,1例发生术后气管瘘,1例发生术后切开感染,均经积极处理后生命体征稳定或治愈.1例拟建立体外循环但未成功的患者经历6 min低氧.所有体外循环病例无论是否为紧急情况,转流中均血流动力学稳定,围手术期无大量输血情况.结论 大部分气管手术可通过谨慎的麻醉技术操作和与手术医生的密切配合使患者安全度过围手术期,体外循环是气管手术重要的安全保障措施之一.建立适应气管外科的微创体外循环具有重要意义.