颌面整形外科经鼻气管插管静吸复合全身麻醉的应用及管理体会.pdfVIP

1394 中国美容医学 2011年9月第2O卷第 9期 ChineseJournalofAestheticMedicine．Sep．2011．Vo1．20．No．9 颌面整形外科经鼻气管插管静吸复合全身麻醉的应用及管理体 陈 丽，李永荣，程希熊 (四川华美紫馨医学美容医院麻醉科 四川 成都 610041) 摘【要]目的：介绍经鼻气管插管静吸复合全身麻醉用于颌面整形外科中的经验，探讨颌面整形外科术中的管理体会，提高手术 安全性，降低手术死亡率。方法：颌面整形外科手术538例，ASA分级 I～II级，年龄 19～58岁，均实施静吸复合全身麻醉，其中 经鼻气管插管535例，另 3例因经鼻插管困难或手术原因改行经口气管插管 结果：I例因困难气道，气管插管失败放弃手术，1 例因困难气道实施经鼻气管插管困难改行经口逆行气管插管成功，术毕出现喉头水肿，环甲膜穿刺后通气障碍不能完全缓解行 气管切开，3例在纤支镜辅助下气管插管成功。术后13例因出血血肿进行紧急气道处理。讨论：气管插管静吸复合全身麻醉是 颌面整形外科最安全的麻醉方式，便于气道管理，经鼻插管较经口插管而言，不影响手术操作且固定性好，术毕可留作鼻咽通气 道之用，颌面整形外科术操作复杂，术中术后均可能出现出血血肿、呼吸道梗阻，威胁患者生命，呼吸道管理尤为重要。 [关键词]颌面整形外科；经鼻气管插管静吸复合全身麻醉；呼吸道管理；失血；呼吸道梗阻 【中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2011)09—1394—03 Maxillofacialsurgeonanesthesiaandmanagementexperience CHEN Li，LiYong-rong，CHENGXi—xiong (DepartmentofAnesthesiology，SichuanHuameiZixinMedicineAestheticHospital，Chengdu610041，Sichuan，China) Abstract：Objective Toapplynasotrachealintubationand inhalationcompositegeneralanesthesiaformaxillofacial plasticsurgeryandtointroduceperioperativemanagementexperience，improvethesafetyoftheoperationandreduce operation mortality． M ethods 538 maxillofacialplastic surgery patients recieved inhalation composite general anesthesia，ASA I～ IIlevel，age 19-58yearsold，535casesOfnasotrachealintubationandthreecaseoforotracheal intubationbecauseofnasalintubationdifficultiesorothersurgicalreasons．Results 1caseOfdifficultairwayabandon surgery because ofunsuccessfultrachealintubation．1 case ofdiffculty airway who received orotrachealintubation occured laryngealedema afterdrawing trachealintubation，then followed cricothyrotomy because the cricothyroid membranepuncturecannotreleivetheairwayobstructioncompletely．3casesacquired successfultrachealintubation withtheassistantofbr0nchOfibersc0pe．Amongthecases，13casesoccuredhematomaandtooktheairwayemergency measures．Conclusion TracheaIintubationinhalation