CO2激光喉手术中气管内燃烧的分级预防策略

目的　气管内燃烧三级预防策略在支撑喉镜下CO2激光手术中预防气管内燃烧这一并发症的意义。方法　回顾1992年2月～2016年12月于北京同仁医院行支撑喉镜下CO2激光手术的喉肿物患者，第一阶段1992年2月～2008年12月，第二阶段2009年1月～2016年12月。比较这两个阶段术中发生气管内燃烧的差别。结果　4例气管内燃烧均发生于第一阶段，其中3例为声门型喉癌，1例为声带息肉及任克水肿。第二阶段未发生气管内燃烧。2例激光打破套囊后被及时发现，但未更换气管插管，将吸入氧浓度百分比（fraction of inspiration O2，FiO2）从70%降至30%，盐水纱条填塞套囊上区后，继续行激光手术致气管内燃烧；另外2例术中未发现套囊破损，气管内燃烧发生时FiO2为70%。1例出现颈段气管狭窄，需长期带气切套管；其余3例无严重术后并发症。结论　支撑喉镜下CO2激光手术中喉气管内燃爆的三级预防策略有利于防止气管内燃爆的发生。

Grading prevention strategy for airway burn during CO2 laser surgery of larynx

OBJECTIVE To explore t he significance of reducing the incidence rate of airway burn of CO2 laser laryngeal surgery by spreading the idea of grading prevention st rateg y. M ETHODS We retrospectively reviewed the data of laryngeal lesions treated by the endoscopic CO2 laser surgery from Feburary 1992 to December 2016. The period was divided into two stages, the first one is from Feburary 1992 to December 2008, and the second one is from January 2009 to December 2016. We will distinguish the difference of airway burn between the two stages. RESULTS Four cases of airway burn were found in the first stage including 3 cases of glottic cancer and 1 case of vocal cord polyp with Reink's edema. But no airway burn happened in the second stage. Two cases of endotracheal intubation cuff broken by laser were found promptly, but with FiO2 decreasing from 70% to 30%, wet gauze filling subglottic region and the endotracheal tube reserved, the laser surgery proceeded till airway burn happened. The endotracheal intubation cuffs of the remaining two cases kept intact intraoperatively, the FiO2 was 70% when airway burn happened. One case had the cervical tracheal stenosis with long-term tracheotomy, The other 3 cases had no postoperative complications. CONCLUSION The grading prevention strategy is helpful for reducing airway burn during the CO2 laser surgery of larynx.