严重颏胸粘连病人纤支镜引导气管插管建立人工气道

Clinical Experience to Establish Artificial Airway in Intubation with Fiberbronchoscope for Patients of Severe Mento-sternal Adhesion.

目的:探讨纤支镜引导气管插管在严重颏胸粘连病人中的应用效果。方法:选择30例ASAⅠ～Ⅲ级患者,男性18例,女性12例,体重48～80公斤。此类患者均为特重度大面积烧伤愈合后瘢痕挛缩畸形病人,使头部后仰受限,造成气管插管困难。静脉全麻慢诱导药物为力月西、芬太尼。所有病例均在直接喉镜无法暴露声门,经面罩加压无法给氧,慢诱导保留自主呼吸配合表麻下操做。结果:采用本法插管后30例患者中,均1次成功,历时1分钟～3分钟,成功率100%。术后随访未见气管插管相关并发症。结论:采取纤支镜引导气管插管建立人工气道用于颏胸粘连困难插管中是可行的,可明显提高插管成功率。

Objective： To discuss the application of establishing artificial airway with fiberbronchoscope in intubation for patients of severe mento-sternal adhesion. Method： 30 cases （18 female and 12 male with weight of 40-80kg） of patients with ASA level of 1-3 degree were collected.All cases collected were the patients with severe contracture scar deformity resulted from large area burn and they all had intubation difficult because their head backward was limited greatly.Midazolam and fentanyl were used as slow intravenous anesthesia-inducing drugs.In the conditions that glottis could not be exposed to direct laryngoscopy and mask oxygen inhalation could not be made through overpressured mask,all cases were established artificial airway under their retaining spontaneous breath with slow introduction plus surface anesthesia operation.Results： The intubation of all of 30 cases succeeded once with 100% successful rate,lasting a period of 1-3min.No complications of intubation were observed after following-up visits.Conclusion： It is an feasible way to establish artificial airway with fiberbronchoscope in intubation for patients of severe mento-sternal adhesions,that can improve the success rate of intubation.