吸入性损伤后预防性气管切开与紧急气管切开的临床研究

目的　探讨预防性气管切开的临床可行性。　方法　对 93例中度或重度吸入性损伤患者均行气管切开。气管切开前出现明显呼吸困难、血氧分压下降、血氧饱和度下降者为紧急气管切开组 (2 1例 ) ;气管切开前未出现明显通气、换气障碍者为预防性气管切开组 (72例 )。预防性气管切开组实施手术时间为伤后 (4 .31± 3.0 4 )h ,紧急气管切开组为伤后 (34.4 7± 2 .79)h。比较两组患者相关生命体征、血氧分压、氧饱和度、呼吸频率及呼吸机使用情况。　结果　紧急气管切开组血氧分压、血氧饱和度、呼吸频率、心率等术前均有明显的异常 ,术后得到显著改善 ,而预防性气管切开组相关生命体征较平稳。紧急气管切开组术后 2d内 2 0例使用呼吸机辅助呼吸 (95 .2 4 % )。预防性气管切开组术后 2d内 6 5例使用呼吸机辅助呼吸 (90 .2 8% )。　结论　对疑有中度以上吸入性损伤的患者应及早行预防性气管切开 ,尽量避免紧急气管切开。气管切开后建议早期使用呼吸机辅助呼吸。     

气管狭窄重建术的麻醉体会

气管肿瘤或其他原因造成的气管狭窄是一种少见病,患者常伴有严重的呼吸困难,给麻醉带来了较大难度。我院对2例气管狭窄症患者进行了手术重建,现将有关麻醉体会报道如下。例1女,52岁,因胸闷气促渐行加重半年入院,CT等影像学诊断为声门下3cm气管环状肿瘤,2cm×3cm大小,伴严重气管     

气管切开在抢救重症脑出血中的应用

在抢救重症脑出血病人的过程中,确保呼吸道通畅,改善脑组织的缺氧状态,阻断颅内压增高的恶性循环,降低和控制昏迷状态下病人的肺部感染,气管切开是十分有效的措施。我科1993年6月～2003年6月间在抢救重症脑出血病人中共行气管切开117例,现分析总结如下:1临床资料1.1一般资料:本组117例,男73例,女44例。高血压脑出血临床分级[1]:Ⅲ级96例,Ⅳ级21例。根据多田公式血肿量40～60ml45例,61～80ml51例,80ml以上21例。1.2气管切开指征:①舌根后坠,呼吸道有分泌物或呕吐物影响呼吸又可能引起窒息者;②脑出血后出现神经源性肺水肿、原有慢支等肺病,气…     

气管隆凸切除重建术在呼吸道肿瘤外科治疗中的应用

目的 总结气管隆凸切除重建术在呼吸道肿瘤患者中的手术治疗经验，探讨合理的手术方法及治疗措施。方法 回顾分析1996年1月～2004年6月，27例气管隆凸肿瘤患者的临床资料。结果 行气管肿瘤切除＋对端吻合8例；右全肺＋隆凸切除，气管与左主支气管对端吻合6例；左全肺＋隆凸切除，气管与右主支气管对端吻合3例；右上肺叶＋隆凸袖式切除，气管＋左主支气管＋右中间支气管“品”字吻合2例；隆凸切除，气管＋左主支气管＋右主支气管“品”字吻合3例；气管肿瘤及气管壁部分切除或刮除5例，其中体外循环辅助下完成手术2例。术后早期死亡3例，2例术后早期死于多器官衰竭，1例系胸腔感染、出血，术后21d死亡。半年以上随访，无死亡，无外科并发症。结论隆凸及气管手术比较复杂，手术难度大，选择合理的术式及麻醉方法，必要时应用体外循环技术，可以取得满意的疗效。     

高频通气在气管隆突重建术中的应用

目的 评价高频通气应用于气管隆突重建术的可行性。方法 择期肺癌需行气管隆突重建术患者１０例,常规麻醉诱导,插入双腔气管导管,开胸新开健侧主支气管后行高频通气,呼吸频率（ＲＲ）１２０次／ｍｉｎ,呼吸比（１：Ｅ）１：２,驱动压力０．１５～０．２０ＭＰａ。连接一条高频喷射通气导管（内径３ｍｍ）,插入一侧主支气管内３ｃｍ,并在术前、单肺通气后１５ｍｉｎ、高频通气后５ｍｉｎ、１０ｍｉｎ、２０ｍｉｎ及再次单肺     

紧急快速气管切开在破伤风患者中的应用

据报道，目前国内破伤风的平均死亡率为１０％～３０％。其中因窒息而死亡的占整个疾病死亡的７０％～８０％。在多年的临床工作中笔者发现破伤风病人因突然的抽搐而致喉肌痉挛造成窒息时，利用传统的气管切开法，往往在切开气管后，因为窒息时间较久，致使病人呼吸不能恢...     

自制木塞在气管切开试堵管中的应用

气管切开术是临床常用的急救技术，行气管切开术后患者拔管前必须试堵管，而目前临床上还没有一种很满意的堵管物。笔者于2006年11月自行设计用热水瓶瓶塞作为堵管物，经临床应用，取得较好的效果，介绍如下。     

气管隆突切除及重建术治疗中心型支气管肺癌

本文报告１０例侵及气管隆突或距隆突０．３ｃｍ以内的中心型支气管肺癌行气管隆突切除及重建术，其中右上叶及隆突切除重建术３例，右全肺及隆突切除２例，左全肺及隆突切除４例，左上叶及隆突切除重建术１例，加部分左心房切除术３例。本组根治切除９例。姑息切除１例。术后并发症３例（３０％）。术后无癌生存６年１例，３年１例，２年１０月１例，２年６月３例，１年２例，半年１例；另１例于术后８月死于脑转移。重点讨论了手术适应证、手术方法、围手术期监护和处理。     

渐进式堵管器在气管切开患者堵管中的应用

目的探讨渐进式气管套管堵管器在气管切开患者堵管中的应用效果。方法将40例气管切开患者使用随机数字表法分为干预组与对照组各20例。对照组使用橡胶瓶塞全堵管,干预组使用自制气管套管堵管器堵管,从1/2逐渐过渡到3/4,最后达到完全堵管。结果干预组堵管24 h、48 h PaO_2显著高于对照组,PaCO_2显著低于对照组,堵管时间显著短于对照组(均P0.01);干预组拔管成功率(95.0%)高于对照组(85.0%)。结论渐进式气管套管堵管器可缩短患者的堵管时间,提高拔管成功率。     

自制木塞在气管切开试堵管中的应用

气管切开术是临床常用的急救技术,行气管切开术后患者拔管前必须试堵管,而目前临床上还没有一种很满意的堵管物.     

Tracheal resection and reconstruction for tracheal stenosis

Five patients underwent surgery for tracheal stenosis. The cause of stenosis was congenital tracheal stenosis in 1 case, post-intubation tracheal stenosis in 1 case, and tracheal stenosis due to thyroid cancer invasion in 3 cases. All 5 patients required circumferential tracheal resection and end-to-end anastomosis using 4-0 or 5-0 absorbable sutures. The number of tracheal rings removed ranged from 3 to 6. There was no anastomotic complication. Technical points of this procedure were summarized as follows : 1) the circumferential dissection of the trachea should be made only at the level of the lesion that is to be excised, 2) preserve at least one side of recurrent nerve, 3) the traction sutures facilitate tensionless knot of the sutures, 4) prevention of excessive extension of the neck in the immediate postoperative period.     

Experience with tracheal resection for traumatic tracheal stenosis

Ten patients with traumatic tracheal stenosis--unresponsive to conservative therapy--underwent tracheal resection. Two of the stenoses resulted from gunshot injuries, three were due to prolonged intubation, and five developed after tracheotomy. Eight of the operations were completely successful. There was one death, and one patient has had recurrent granulation tissue at the anastomotic site. The pathogenesis of tracheal stenosis, as well as its treatment--including the technical details of tracheal resection--are discussed.     

Aortopexy with tracheal reconstruction for postoperative tracheomalacia in congenital tracheal stenosis

PurposeCongenital tracheal stenosis is a rare condition and can be difficult to manage. One source of difficulty is postoperative tracheomalacia requiring long-term tracheal stenting. To prevent symptomatic postoperative tracheomalacia, we have been adding aortopexy to tracheal reconstruction since 2008. The aim of this study was to evaluate efficacy of aortopexy for preventing postoperative tracheomalacia after reconstruction of congenital tracheal stenosis.MethodsRetrospective chart review was conducted. From October 2003 to March 2011, 24 had tracheal reconstruction without aortopexy (group A) and 8 with aortopexy (group B). Statistical analysis was performed using Fisher's Exact test.ResultsOne had anastomotic leakage in group A, and 1, in group B (P = .44). Eleven patients required tracheostomy because of postoperative tracheomalacia confirmed by postoperative bronchoscopy in group A vs none in group B (P = .029).ConclusionsWe found that aortopexy with tracheal reconstruction reduced the need for postoperative tracheostomy in this patient group. Although there is a potential risk of anastomotic leakage because of the suspension suture on the anterior tracheal wall to aorta, we did not detect an increased incidence after aortopexy. Thus, aortic suspension may be a useful adjunct to prevent symptoms of tracheomalacia in these patients.     

Results of transverse tracheal resection in post-intubation tracheal stenoses

Tracheal problems in form of stenosis and malacia are a calculated risk of long-term tracheal intubation. Results with conservative treatment of such problems by bougienage, laser therapy, biopsy, cryotherapy, local steroids, tracheal stenting, and tracheostomy are not satisfactory in a higher percentage of cases. Resectional therapy of benign tracheal lesions has become an established technique, which combines excellent functional results with a low complication incidence. We have treated 40 patients of 17 to 76 years of age with postintubation tracheal lesions by cross resection of the affected segment. Of these patients 40% had received conservative therapeutical steps preoperatively. The mean resection length was 3.0 cm (1.5 to 6.5 cm). The perioperative morbidity was 7.8%, mortality was 2.5%. 85% of the patients operated between 1970 and 1989 were reached for a follow-up examination with x-ray, pulmonary function test and endoscopy. The patients subjective satisfaction with the operative result was good in 85%, minor in 12% and less in 3%. The objective investigations proved very good results in 90%. Our experience confirm the good results of other authors and recommend the resection treatment for cases of postintubation tracheal lesions.     

Oxygen-jet ventilation during tracheal reconstruction in patients with tracheal stenosis

Intermittent jets of O2 at 60 psi via a small bore (5 mm), cuffed tracheal tube have been used relaxants to ventilate adult patients with tracheal stenosis undergoing surgical resection and reconstruction. Before resection, the tube was maintained proximal to the stenosis. During resection and reconstruction, the tube bypassed the resected gap into the distal tracheal segment. The technic allows the surgeon to mobilize, resect, and reconstruct the trachea around the small tube in an unhurried manner, and provides adequate ventilation and oxygenation throughout the procedure.     

气管球囊扩张后气管切开抢救颈段气管狭窄致患者窒息的临床分析

<正>近年来,颈段气管狭窄的发生率在临床有增多趋势。颈段气管狭窄可引起不同程度的呼吸困难,严重者可导致窒息死亡。若患者出现急性喉梗阻,由于颈段气管狭窄而不能行气管插管,则低位气管切开是目前抢救患者的唯一有效措施,但此类患者呼吸困难较重,局部麻醉下行气管切开术的风险较大,极易在手术     

Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis

The anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical reanastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.     

Anesthesia for a cervical myelopathy patient with tracheal stenosis

A 71-year-old male with cervical myelopathy was scheduled for C 3-7 laminectomy. Once he had been rejected of general anesthesia in other hospital because of his tracheal stenosis. The diameter of the narrowest part of his trachea was 5 mm probably resulting from tracheostomy at 2 years of age. His cervical myelopathy seemed to be no problem for anesthesia induction because he had no problems in his neck movement and opening mouth. We evaluated his tracheal stenosis carefully using bronchofiberscopy, chest X-ray, computed tomography and pulmonary function tests. After intravenous fentanyl 100 micrograms and midazolam 2.5 mg, it was impossible to ventilate the patient. Therefore, tracheal intubation was performed immediately after lidocaine administration into the trachea. During surgery, tracheal tube dilated the narrowed portion. After surgery, the tracheal tube was removed under bronchofiberscopic observation without any problems. Tracheal stenosis was observed by chest X-ray after surgery, but he had no complaints.