创伤患者弹性插管探条引导下紧急逆行气管内插管一例

背景：保证严重颌面部外伤患者的气道安全是有一定难度的。通常情况下，使用喉镜或纤维支气管镜气管插管失败后，可通过紧急外科手术建立气道。但当外科手术仍然不能建立气道时，麻醉医师就必须采用一些新的方法来进行气道管理。但是，现有的文献很少对这些技术进行描述。方法1例创伤后颌面部变形的患者，在使用直接喉镜气管插管失败，环甲膜切开和气管切开同样失败之后，从气管破口处向头侧逆行插入弹性插管探条，使其从患者口腔内伸出。结果运用改良的逆行插管技术，从气管破口处使用弹性插管探条成功完成了插管。结论当通过外科手术仍然无法控制气道时，如果气管存在破损，则可以考虑使用弹性插管探条进行逆行插管。

BACKGROUND： Patients with severe maxillofadal trauma pose a challenge when their airways must be secured. Often, emergent surgical airways are established when largyngoscopy or fiberoptic intubation are tmsuccessftfl. When an airway cannot be surgically established, the anesthesiologist is forced to use novel approaches to airway management, but there are few descriptions of such techniques in the literature. METHODS： After unsuccessful laryngoscopy and a failed cricothyroidotomy and tracheostomy in a patient with deforming maxillofacial trauma, a gum-elastic bougie was inserted retrograde through a tracheal defect in a cephalad manner and exited the patient＇s mouth. RESULTS： The patient was successfully intubated using a modified retrograde technique through a tracheal defect with a gum-elastic bougie. CONCLUSIONS： When an uncontrolled airway cannot be secured surgically and a tracheal defect is present, retrograde intubation with a gumelastic bougie may be considered as an emergent management option.