联合麻醉用于颈段气管重建术效果观察

目的 :比较连续高位硬膜外阻滞复合气管内插管全麻与单纯气管内插管全麻在颈段气管切除重建手术中的应用效果。方法 :2 1例择期颈段气管肿瘤患者 ,随机分为两组 :A组 11例 ,先在连续高位硬膜外阻滞下游离气管肿瘤 ,切除重建时再复合气管内插管静吸互补全麻 ,控制呼吸 ;B组 10例 ,单纯气管内插管静吸互补全麻。两组患者麻醉诱导药物相同 ,均辅吸氨氟醚加深麻醉。结果 :A组在麻醉前后 ,重建前 Sp O2 ,动脉 Pa O2 ,Pa CO2 均没有显著差异 ( P >0 .0 5 ) ,重建后有显著改变 ( P <0 .0 5 )。麻醉诱导平稳 ,插管应激反应轻 ,全麻药用量少 ,术毕清醒快 ,与 B组相比有显著差异 ( P <0 .0 5 )。结论 :高位硬外阻滞复合气管插管全麻 ,既避免了先行气管插管因肿瘤浸润管腔变窄所致的插管困难、瘤体损伤脱落、出血引起的气道梗阻的危险 ,又有效保证了重建前后充分供氧 ,为气管外科手术提供了一种安全、平稳的麻醉方法及呼吸管理方式。

Observation of compound anesthesia used in neck tracheotomy reconstruct

Objective:It is to contrast the effect of neck tracheotomy reconstruct with continuous upper epidural anesthesia compound trachea intubation and merely trachea general anesthesia intubation.Methods: 21 cases with neck trachea tumor were divided into two groups. 11 cases of group A dissociate trachea tumor on continuous upper epidural anesthesia firstly, then compound in trachea to control breathe when resection and reconstruct. 10 cases of group B were used merely trachea general anesthesia intubation. The two groups` anesthesia induction drugs are same. Results: SpO 2, PaO 2, PaCO 2 of group A have not remarkable difference before and after anesthesia, but there are remarkable difference after reconstruct anesthesia induction stable, intubation reactions slightly, general anesthesia drugs less, regain consciousness quickly after operation, there are remarkable difference compare with group B.Conclusion:Upper epidural anesthesia compound trachea general anesthesia intubation both avoid difficult intubation because of tumor infiltration trachea lead to trachea narrow, tumor injure and drop, hemorrhage cause trachea obstruction dangerous, and guarantee effectively oxygen. It provides a safe and stable anesthesia way and breathing manage fashion.