重度气道狭窄置放国产镍钛记忆合金支架的方法学研究

Evaluation of domestically made recalled nitinol ahoy stent implantation for severe airway stenosis

目的对重度气道狭窄患者置放国产镍钛记忆合金支架的方法学进行初步评价。方法应用全身麻醉下分别采用经喉罩、气管插管或硬质气管镜的方法对2005年11月至2009年4月收入北京天坛医院呼吸科的40例难以在局部麻醉下操作的重症气道狭窄患者置入国产镍钛记忆合金气道支架。结果40例患者根据病变部位及病变特点选择经喉罩23例，气管插管11例，硬质气管镜6例，并予全身麻醉及机械通气，共放置了42枚支架：气管支架27枚（其中覆膜支架9枚）、左主支气管支架8枚、右主支气管至右中间段支架2枚、气管至左主支气管楔形支架5枚。在全身麻醉、机械通气维持患者各项生命体征的条件下，所有病例都顺利置入，未出现并发症。支架释放后所有病例气道压力即降至正常，同时其他机械通气参数也恢复正常。大部分患者呼吸困难指数分级由Ⅳ-Ⅴ级改善到0～Ⅱ级。结论对于重度气道狭窄患者，在全身麻醉下经喉罩、气管插管及硬质气管镜的方法可以顺利放置局部麻醉下难以操作的各种高难度气道支架的置放，并且安全、有效、舒适，值得在临床进一步推广。

Objective It is more difficult and carries more risks to place airway stent under local anaesthesia for the patient with severe airway stenosis. The technique and method of domestically made recalled nitinol alloy stent implantation for severe airway stenosis was explored and evaluated. Methods By using bronchoscopy via larynx mask, trachea intubation, or rigid bronchoseope under general anaesthesia and mechanical ventilation, stents are placed in the airway of patients with severe airway stenosis for which had been difficult to performed under local anaesthesia. Results According to the various tracheobronehial lesions of patients, 42 stents were successfully placed in 40 patients, via larynx mask 23 cases, trachea intubation 11 eases, and rigid bronehoscope 6 eases under general anaesthesia and mechanical ventilation. No complications happened. The recalled nitinol alloy stents were placed in trachea 27 cases （membrane covered stent 9 eases） , left primary bronchus 8 cases, right primary bronchus to medial segment 2 eases, trachea to left primary bronchus （wedge shaped stent） 5 eases respectively. The airway pressure decreased to normal level and other ventilator parameters also recovered after stents were placed. In most patients, the dyspnea index was improved immediately and the scores decreased from grades Ⅳ-Ⅴ to grades 0-Ⅱ , with higher scores indicating worse dyspnea. Conclusion For patients with severe airway stenosis, it is safer, effective and more comfortable to place the stent via larynx mask, trachea intubation, or rigid bronchoscope under general anaesthesia and mechanical ventilation compared to local anaesthesia and is worth spread and popularization in the future.