螺旋CT重建成像分析在气管狭窄患者麻醉中的应用

The application of tracheal reconstruction by spiral CT in anesthesia of patients with tracheal stenosis

目的探讨螺旋CT重建成像分析在气管狭窄患者麻醉中的应用价值。方法选择拟行气管插管全身麻醉,X线胸片示气管受压狭窄的甲状腺疾病患者13例。术前患者从舌骨上缘至颈7下缘行螺旋CT扫描。选择CT模拟支气管镜、多平面重建技术重建图像。测量气管受压狭窄段的长度;气管受压狭窄段末端距环状软骨的距离;气管受压狭窄最严重处的直径、横截面积;未受压处气管的直径、横截面积。按Cotton(1989)分级标准评定患者的气管狭窄程度。气管狭窄程度Ⅰ级的患者,予常规诱导、直接喉镜气管插管,术后患者呼吸恢复后拔除气管导管;气管狭窄程度Ⅱ～Ⅲ级的患者,予芬太尼0.05mg、丙泊酚1～2mg·^(-1)镇静、镇痛,表面麻醉下经纤维支气管镜气管插管,术后带气管导管入ICU治疗。结果 13例患者中,气管狭窄程度Ⅰ级10例,气管狭窄程度Ⅱ级3例。气管狭窄最严重处直径3.4～9.3mm,平均(6.5±1.3)mm;气管狭窄最严重处横截面积0.82～1.23cm^2,平均(1.03±0.8)cm^2;狭窄段长度2.8～6.0cm,平均(4.5±0.8)cm;气管狭窄段末端距环状软骨5.0～7.1cm,平均(6.1±0.5)cm。13例患者均成功完成麻醉诱导插管,且首次插管成功率为100%。术后,10例患者呼吸恢复后拔除气管导管,3例患者入ICU治疗24～48h后拔除气管导管。13例患者均康复出院。结论麻醉前行螺旋CT气道重建成像分析,对指导气管受压狭窄患者的围术期气道管理及提高该类患者麻醉的质量与安全性有重要意义。

Objective To evaluate the application ol tracheal reconstruction by spiral CT in the anesthesia of patients with tracheal stenosis.Methods Thirteen patients planned for general anaesthesia with tracheal intubation for their thyroid disease accompanied by tracheal stenosis revealed by chest roentgenogram were selected in this study.Spiral CT scanned from the level of the upper edge of hyoid bone to the seventh cervical vertebra in these patients.Multiplanar reconstructions were performed in each of these patients.Measurements were performed on the length of the stenosed segment of trachea,the distance from the distal end of the stenosed segment of trachea to cricoid cartilage,the diameter and cross section area of the most severely stenosed segment of trachea,and the diameter and cross section area of the non-stenosed part of trachea.The degree of tracheal stenosis was evaluated according to the Cotton classification（1989）.Patients classified as gradeⅠwere conventionally induced and intubated with direct laryngoscope,and extubated once their spontaneous respiration well recovered after operation.Patients classified as gradeⅡtoⅢwere sedated with 0.05 mg fentanyl and l-2mg·kg^（-1） propofol,intubated with fiberoptic bronchoscope under topical anesthesia,and transferred to ICU with the tracheal tube post operation.Results The diameter of trachea at the site of maximal stenosis ranged 3.4 - 9.3 mm,averaging（6.5±1.3） mm in 13 patients judged under reconstruction by spiral CT;the cross section area of trachea at the site of maximal stenosis ranged 0.82-1.23 cm^2,averaging（1.03±0.8） cm^2;the length of the stenosed segment ranged 2.8 -6.0 cm, averaging（4.5±0.8） cm;the distance between the distal end of the stenosed segment and cricoid cartilage ranged（5.0 -7.1 ）cm,averaging（6.1±0.5） cm.As for the degree of stenosis according to Cotton classification,10 cases were classified as gradeⅠ,3 cases as gradeⅡ.Intubation was successfully performed in all the 13 cases,with an initial success rate of 100%.After operation, extubation was successfully carried out in 10 cases once their spontaneous respiration well recovered as well as the other 3 cases after 24 - 48 hours stay in ICU.All the 13 cases were discharged with a healthy status.Conclusion Spiral CT scan of the cervical region and trachea reconstruction in the patients with tracheal stenosis can guide tracheal intubation and enhance the anaesthesia security.