34例颊癌根治术患者的气道管理

The airway management of 34 patients underwent the radical operation of buccal carcinoma

目的:回顾34例颊癌根治术患者气道管理,为此类手术的麻醉气道管理提供参考。方法:收集颊癌根治术患者34例资料,统计不同插管方案的一次插管成功率、插管期间低氧血症及插管并发症的发生率;以及术后未拔管、拔管、气切及转入ICU的发生率。结果:34例中可视喉镜引导下经鼻气管插管15例,纤支镜引导下经鼻气管插管8例,清醒镇静纤支镜下经鼻气管插管10例,气管切开1例。清醒纤支镜插管一次插管成功率高,插管期间低氧血症及插管并发症的发生率低(P<0.05)。34例中术后未拔管23例(67.6%),拔管4例(11.8%),气切7例(20.6%),转入ICU 6例(17.6%),张口受限情况在气管切开组和转为ICU组较重(P<0.05)。结论:颊癌根治术患者选择清醒纤支镜插管方案,术后带气管导管回ICU,可能会使其更安全地度过围术期。

Objective:To retrospectively analyse of anesthesia airway management in 34 patients underwent radical operation of cheek cancer.Methods:The medical records of 34 patients underwent elective radical operation of buccal carcinoma were retrospectively analysed.The success rate of one intubation,the incidences of hypoxemia during intubation and the incidence of intubation complications in three intubation protocols were analyzed.The incidences of unextracted,extubated,tracheotomy and transferred to the ICU after surgery were also calculated.Results:15 cases were given laryngoscope-added transnasal intubation,8 fiberbronchoscope added intubation,6 trasnasal fiberbronchoscope intubtion under conscious-sidation and 1 tracheotomy.The success rate of one intubation was higher in the cases with awake fiberoptic intubation.The incidence of hypoxemia and intubation complications during intubation was lower in the awake fiberoptic intubation(P<0.05).When the operation was ended the endotracheal tube was kept in 23 cases(67.6%),the tube was removed in 4 cases(11.8%),7(20.6%)cases underwent tracheotomy,and 6(17.6%)were given ICU management(P<0.05).Conclusion:Awake fiberoptic intubation protocol and returning to the ICU with an endotracheal tube may result in a safer perioperative period in patients with radical cheek cancer.