四种插管技术解决气道困难的比较研究

目的观察比较四种插管技术解决气道困难的效果。方法将120例口腔颌面外科气道困难病例等分为4组,分别选用不同的插管技术进行清醒插管。组1用传统盲探技术,组2用逆行引导技术,组3用盲探插管新技术,组4用纤维光导喉镜引导技术。观察其插管效果、对循环和呼吸的影响以及并发症情况。结果4组插管成功率分别为76.7%(23/30)、93.3%(28/30)、100%(30/30)和100%(30/30),组1插管成功率明显低于其它各组(P<0.05);4组2次以上操作成功率分别为65.2%(15/23)、7.1%、6.7%和10%,组1明显高于其它各组(P<0.05);4组插管时间分别为(12.1±8.6)min、(4.2±1.3)min、(3.9±2.1)min和(3.7±2.2)min,组1较其它各组明显延长(P<0.05);插管过程中,4组循环和呼吸功能无明显变化;所有病例未见严重并发症。结论掌握各有不同特点的四种插管技术,有助于提高处理气道困难的综合水平。     

基于logistics回归分析可视喉镜暴露声门困难相关面部特征

目的 利用logistics回归分析探究与可视喉镜暴露声门困难相关的面部特征指标。方法 选择2020年8月起全麻下行颅颌面手术需气管插管的患者,ASA I-II级。手术麻醉前获得患者年龄、性别、身高、体重、BMI等信息,采集患者正面中立位、张口伸舌及仰头姿势的照片,将标注的面部特征进行定量化。5年以上临床经验麻醉医生用可视喉镜进行气管插管时,由统计者记录Cormack-lehane等级(C-L等级)。根据C-L等级将受试者分为可视喉镜暴露声门容易组（C-L评分Ⅰ-Ⅱ级）和可视喉镜暴露声门困难组（C-L评分Ⅲ-Ⅳ级）。获得的可视喉镜暴露声门困难受试者基于年龄（差异不大于2岁）和性别进行可视喉镜暴露容易受试者1：1匹配,将两组患者的面部特征指标与可视喉镜暴露声门的真实结果进行单因素和多因素logistics回归分析,归纳出具有评估作用的阳性指标。结果 成功匹配31对受试者,受试者年龄区间在15-75岁之间,可视喉镜暴露困难组平均年龄49.29±17.47岁,可视喉镜暴露容易组平均年龄49.23±17.47岁,两组在BMI水平上没有显著差异（可视喉镜暴露困难组BMI VS 可视喉镜暴露容易组BMI 22.18±3.55 VS 23.33±3.06,P=0.081）。面部特征中,眉心至鼻尖距离所占额骨鳞部体表冠状面顶点处至下颏距离比例（P=0.002）和伸舌受限(P=0.002)在对照组与病例组存在差异。多因素logistics回归分析发现,眉心至鼻尖距离所占额骨鳞部体表冠状面顶点处至下颏距离比例增大在可视喉镜暴露容易组与可视喉镜暴露困难组间存在显著差异。在纳入眉心至鼻尖距离所占额骨鳞部体表冠状面顶点处至下颏距离比例、伸舌受限和BMI的logistics回归模型中,眉心至鼻尖距离所占额骨鳞部体表冠状面顶点处至下颏距离比例优势比OR为1.25,P=0.033。结论 可视喉镜暴露声门困难的患者存在一些区别于正常患者的面部特征,值得更多前瞻性研究进行进一步全面的探究。     

Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes

Objectives: To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications.

Methods: All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale.

Results: The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1?hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58?±?12.02 (range =15–70) mm. Mean follow-up for the study group was 60.16?±?34.10 (range =18–137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%).

Conclusion: T-tube is not an effective treatment of tracheal stenosis.     

Severe bradycardia associated with suspension laryngoscopy

Suspension laryngoscopy is one of the most common procedures performed for visualizing and diagnosing diseases of the larynx. A relatively uncommon yet potentially life‐threatening complication is that of severe bradycardia or asystole during manipulation of the larynx. This case report highlights the occurrence of this complication during a routine removal of a true vocal fold lesion at a tertiary medical center and discusses the potential pathophysiological mechanisms and proposed management options for this phenomenon. Laryngoscope, 126:949–950, 2016     

口腔喉部肿瘤术后鼻饲管插管方法的研究

目的 为探讨口腔喉部肿瘤切除术后病人建立最佳进食通道的方法。方法 将85例口腔喉部肿瘤切除的患者,随机分为两组,对照组按常规方法插鼻饲管,实验组采用操作前自鼻腔先后滴入1％呋麻滴鼻液和1％丁卡因,操作时分步间歇进行,并配合有效的心理暗示和手法技巧等措施插鼻饲管,比较两种鼻饲管插管方法效果。结果 经统计分析差异有极显著意义(P<0.005),实验组插管一次成功率及插管伴随症状少优于对照组,一次插管成功率由原来41.86％提高到90.47％。结论 改进方法有效地解决了口腔喉部恶性肿瘤切除术插鼻饲管难的护理问题,具有较高的临床实用价值。     

Intubación en dos pacientes con vía aérea difícil y estenosis traqueal tras traqueostomía en cirugía torácica

Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent^® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL^® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy.     

护理人员对经口气管插管口腔护理认知状况的研究

经口气管插管是救治严重呼吸衰竭患者的重要措施,为临床医生针对呼吸衰竭的各种病因治疗争取时间并创造条件,但是插管又容易引发重症监护病房(intensive care unit,ICU)重要的医院感染问题———机械通气性肺炎(ventilated associated pneu-monia,VAP)的发生。VAP是指机械通气4     

健忘镇痛慢诱导经口明视气管插管术在重症监护病房的临床应用

目的探讨健忘镇痛慢诱导经口气管插管术在重症监护病房(ICU)应用的可行性、安全性及有效性。方法随机选择25例ICU严重呼吸困难清醒病人,年龄22~68岁,采用健忘镇痛慢诱导经口气管插管。观察记录患者的基础值(T0),环甲膜穿刺时(T1)、插管时(T2)和插管后1 min(T3)各时间点的平均动脉压(MAP)、心率(HR)、收缩(SDP)、心率血压双乘积(RPP)、动脉氧分压(SPO2),以及健忘作用与不良反应。结果25例患者中一次插管成功为22例,1例在操作过程中经助手对环状软骨施以压力后二次插入,2例因颈椎活动受限,喉镜暴露困难,经鼻盲探插管成功。术后随访22例无任何插管并发症,2例诉咽喉痛,1例昏迷。全部清醒患者对插管全过程无记忆。插管前后MAP、HR、SDP、RPP、SPO2变化不大,与基础值相比差异无统计学意义(P>0.05)。结论健忘镇痛慢诱导经口明视气管插管术在重症监护病房应用具有安全性,有效性及切实的可行性。     

Dificuldade na laringoscopia e na intubação orotraqueal: estudo observacional

Introduction

Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw‐thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw‐thrust maneuver with laryngoscopy (Cormack‐Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery.

Correlação entre síndrome da apneia obstrutiva e via aérea difícil na cirurgia otorrinolaringológica

Introduction

ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply.