1例巨气管支气管症行胸腔镜下肺大疱切除术的麻醉管理

Anesthesia management of thoracoscopic bullectomy for the treatment of tracheobronchomegaly:one case analysis

巨气管支气管症是临床少见的疾病,患者以中青年为主,疾病特点是气管主支气管明显扩张,黏膜呈扇形向软骨环外突出,严重者呈憩室状。随着疾病进展,部分患者因合并肺大疱、肺气肿而出现自发性气胸、杵状指等;疾病后期可出现呼吸衰竭。此类患者气管环粗大,行胸科手术时,如何选择气道管理工具对麻醉医师提出了挑战。文章报道1例巨气管支气管症患者的麻醉管理,患者术中血流动力学平稳,术后苏醒质量高,拔管后顺利返回病房。总结此病例经验,以期为该类患者麻醉管理提供警示和参考。

Tracheobronchomegaly is a rare clinical condition characterized by marked dilatation of the trachea and main bron-chi,where the mucosa protrudes in the shape of a fan to the cartilage ring,and in severe cases,with the formation of diverticula.The pa-tients are mainly young and middle-aged.As the disease progresses,some patients develop spontaneous pneumothorax and pestle finger due to the presence of pulmonary pustules and emphysema;respiratory failure may occur in the late stage of the disease.Anesthesiolo-gists find it challenging to decide on airway management tools for such patients with large tracheal rings undergoing elective thoracic surgery.The article reports the anesthetic management of a patient with tracheobronchomegaly,who presented smooth intraoperative he-modynamics,with high quality of postoperative awakening,and successfully returned to the ward after extubation.The experience of this case is summarized,in order to provide a warning and reference for the anesthetic management of this type of patients.