经颌下置管全麻在复杂全面部骨折中的应用

Submandibular Approach to Oroendotrachial Intubation in Patients with Panfacial Fracture

目的:介绍特殊全面部骨折手术中一种经颌下置管全麻的方法并探讨其适应症及注意事项。方法:7例全面部骨折、无法实施鼻插全麻患者,口插全麻并稳定后制备口底与颌下间隧道并将气管导管导出颌下、固定。手术结束后将导管导回口腔。结果:所有患者口腔插管和口底导出均顺利,导管位置无改变,双肺呼吸音对称。术中麻醉平稳,管理方便,不影响手术操作。术后局部无气肿、感染、气道阻塞、神经损伤。结论:在无法鼻插全麻前提下,经颌下置管全麻避免了气管切开,同时满足了颌骨骨折术中咬合对位的要求,是特殊全面部骨折麻醉手段的有效方法。

Objective： To introduce the submandibular approach to oroendotrachial intubation in patients with pan- facial fracture and to study its indication and notices. Methods~ Suffered from panfacial fracture and cannot intubed through nose, 7 patients were chosen to intube by the submandibular approach. After routine intubation through o- ral cavity. The tube was guided to the submandibular region through a tunnel, which was prepared from mouth floor to submandihular region,and connected to the anesthesia machine. The fracture operation could be successfully finished without disturbance. The tube was pulled back to oral cavity after operation and submandibular incisions was sutured. Results.. With successful oral intubation and exportation from mouth floor, all patients got satisfactory general anesthesia, and restoration of occlusal relation was not disturbed. No complicated hemorrhage, infection and injure of nerve were found. Conclusion.. When general anesthesia couldnot be perfomed in the patients with panfacial fracture, the submandibular approach to oroendotrachial intubation is an effective measure to avoid tracheotomy and meet demands of restoring occlusion in the fracture operation.