颌面头颈外科术后气道管理困难的手术因素分析

Analysis of procedure factors contributing to postoperative difficult airway management of head neck and maxillofacial surgery

目的 :探讨影响颌面头颈外科手术术后发生气道管理困难的手术因素。方法 :对我院2015年1月—12月间的180例颌面头颈外科术后带人工气道入SICU患者进行回顾分析。根据手术类型分为3组,即肿瘤切除术组(60例)、先天性畸形矫正术组(60例)和创伤手术组(60例)。使用SPSS 13.0软件包对各组围术期资料进行χ2检验和t检验,筛选差异指标。结果:肿瘤切除术组手术和麻醉时间较另外2组长(P<0.05),需行清醒气管插管比例高(P<0.05),术中出血量多(P<0.05),术后带管时间较长(P<0.05)。创伤手术组镇静不足、躁动发生率较另外2组高(P<0.05)。结论:颌面头颈外科手术患者因局部解剖结构改变,出血、水肿压迫气道等原因,气道梗阻风险较高,给予适度的镇静、镇痛,保留气管插管并延迟拔管,可以避免发生严重并发症。

PURPOSE： To summarize the experience in postoperative difficult airway management of head neck and maxillofacial surgery. METHODS： Between January 2015 and December 2015, 180 patients undergoing head neck and maxillofacial surgery with artificial airway in SICU were analyzed retrospectively. The patients were divided into 3 groups according to the type of the operation： tumor resection group（60 cases）, congenital malformation correction group（60 cases） and trauma group（60 cases）. SPSS13.0 software package was used for perioperative statistical analysis. RESULTS：The operation and anesthesia time, the ratio of awake tracheal intubation and the amount of bleeding during operation in the tumor resection group were significantly higher than those in the other two groups（P0.05）, the postoperative tube time was also significantly longer（P0.05） in the tumor resection group. The incidence of sedation and restlessness was highest in the trauma operation group（P 0.05）. CONCLUSIONS： Head neck and maxillofacial surgery often has airway obstruction due to local anatomical structure change, hemorrhage and edema. Use of sedation and analgesia drugs, retained tracheal intubation and delayed extubation can avoid the occurrence of serious complications.