咽部肿物导致术中插管困难1例

A case of difficult intraoperative intubation due to pharyngeal mass

困难气道较常见,但是“不能插管且不能通气”在全身麻醉中是较罕见且凶险的情况。而环甲膜切开术和气管切开术都能够快速改善患者通气状况,但是临床医师面对困难气道或喉梗阻的患者时,大部分医师形成了采用气管切开术的定式思维。现报道1例咽部肿物出血导致术中插管困难,并出现无法插管且无法通气供氧的情况。本文通过详细剖析案例中的麻醉插管及气管切开手术过程中存在的问题,并介绍环甲膜切开术的手术方法以及临床可行性,希望能帮助临床医师提高对术前麻醉评估的重要性,并且加强气管切开术和环甲膜切开术的相关知识的学习,在临床上面对类似患者能够灵活应用手术方式,帮助患者脱离危险。

Difficult airway is common,but"inability to intubate and ventilate"is a rare and dangerous condition in general anesthesia.Both cricothyrotomy and tracheotomy can rapidly improve ventilation,but most clinicians have formed a stereotype of applying tracheotomy to patients with difficult airway or laryngeal obstruction.This paper herein reports a case in which a bleeding pharyngeal mass led to difficult intraoperative intubation and an inability to intubate and ventilate for oxyge n supply.And this paper also analyzes the problems of intubation and tracheotomy under anesthesia in this case and introduces the procedure of cricothyrotomy and its clinical feasibility in detail,aiming to help clinicians understand the importance of preoperative anesthesia evaluation and strengthen the mastery of knowledge about tracheotomy and cricothyrotomy,so that they can apply the procedure flexibly in similar patients in clinical pr actice and help them out of danger.