合并困难气道头颈外科手术的麻醉选择

Anesthesia selection for head and neck surgery with difficult airway

目的探讨头颈手术困难气道的麻醉选择。方法回顾性分析2012年1月到2016年8月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治86例困难气道头颈手术的临床资料。在86例手术中,采取了4种不同类型麻醉方式,方法一:10例行喉罩全麻。方法二:21例在表面麻醉下借助可视喉镜先行气管插管,再行气管切开术,方法三:54例在面罩给氧的情况下,直接行气管切开术,在气切口插入麻醉插管,方法四:另有一例,与胸外科联合,用体外循环技术解决困难气道。结果 6例患者均成功麻醉,完成头颈部手术,其中3例术后第二天开始出现皮下气肿,未特殊处理,气肿渐消退。2例出现气管造口出血,反复凡士林压迫止血后,效果不佳,打开术腔后,结扎止血.1例术后出现气胸请胸外科紧急行闭式胸腔引流术。1例卢德维氏颈炎患者因感染性休克死亡。其余患者未出现呼吸心跳骤停、大出血等严重并发症。结论对于合并有困难气道的头颈手术,采用适宜的麻醉方式,是确保病人度过麻醉手术期的关键。

Objective To investigate the anesthesia selection of difficult airway in head and neck surgery. Methods The clinical data of 86 cases of difficult airway surgery from January 2012 to August 2016 treated in the Otolaryngology Head and neck surgery in First Affiliated Hospital of Medical University Of Anhui were retrospectively analyzed. In 86 cases of head and neck surgery, 4 kinds of different types of anesthesia were used. Method 0ne： 10 cases with laryngeal mask anesthesia. Method two： 21 cases of tracheal intubation with glidescope under topical anesthesia and then tracheotomy. Method three： 54 cases of tracheotomy directly under oxygen mask, and then anesthetic intubation inserted into the air. Method four： Another case, combined with the Department of thoracic surgery, using cardiopulmonary bypass technique to solve the difficult airway. Results All surgeries were successfully completed smoothly under general anesthesia. 3 cases in second days after the operation began to appear subcutaneous emphysema and emphysema gradually subsided without special treatment. 2 cases appeared tracheal incision bleeding, at last, we opened the surgical cavity and stopped the bleeding. Pneumothorax occurred in 1 case, the thoracic surgery doctor placed closed drainage of thoracic cavity. 1 case with Vivtorinox neck inflammation died of septic shock. The rest of the patients had no serious compliations such as respiratory and cardiac arrest, massive bleeding and so on. Conclusion For head and neck surgery with difficult airway, adopts the suitable anesthesia method is the key to ensure patients to pass the anesthesia operation period.