000000ae_颌面部烧伤小口畸形应用支气管镜引导下气管插管.doc

颌面部烧伤应用支气管镜引导下气管插管颌面部严重后瘢痕挛缩畸形的病人插管困难纤维支气管镜引导下气管插管我院20年月—20年月对烧伤插管困难病人手术时采用支气管镜引导下气管插管烧伤插管困难病人手术时采用纤维支气管镜引导下气管插管，由于它的可弯曲性，可以准确地视声门的位置，直视下引导导管插入 气管，保证安插部位的准确纤维支气管镜气管插管烧伤experience of the bronchofibroscope application to the difficult lifesaver of maxillofacial adustum Zhang Liming1 Liu Xincai 2 Zhang Fengwei 2 Jiang Bin3 Wang Yanlai3 Chi Jing 4 1.The Emergency Department of the Second Hospital of Fu Shun 2.The Adustum Department of the Second Hospital of Fu Shun 3.The Anesthesiology Department of the Second Hospital of Fu Shun 4.The Circulation Department of the Second Hospital of Fu Shun 【Abstract】 Objective：summarized 7 paticents with difficult intubation , who were implemented tracheal intubation guided by fiberbronchoscope .These paticents had maxillofacial scar contracture deformity after they suffered severe adustum.Method: We reviewed on clinical data of operated paticents with difficult intubation for maxillofacial adustum in our hospital from March 2008 to November 2010，who were implemented tracheal intubation guided by fiberbronchoscope .Result: Adopting tracheal intubation guided by fiberbronchoscope ,we could accurately determine the glottic position under direct vision ,therefore the catheter was inserted trachea guided by fiberbronchoscope ,which could be bent. By ensureing the intubation position, not only did we provided convenience to general anesthesia ,but also we ensured the safety of the subsequent operation. 【Key word】 bronchofibroscope lifesaver microstomia adustum general anesthesia 气管内插管术是将特制的气管导管通过口腔或鼻腔插入病人气管内，建立人工气道，进行人工通气的一种技术，是目前临床应用最为广泛的一种麻醉方法。但颌面部严重烧伤后瘢痕挛缩畸形的病人，整个颌面部的正常生理解剖结构会发生极大改变，造成喉部结构窥视暴露困难，常规气管内插管会非常困难。我院20年月—20年月对插管困难病人手术时采用纤维支气管镜引导下气管插管，由于它的可弯曲性，可以准确地视声门的位置，直视下引导导管插入气管，保证安插部位的准确我院20年月—20年月纤维支气管镜引导下气管插纤维支气管镜气管插纤维支气管镜纤维支气管镜纤维支气管镜气管插管插管术中? 患者取仰卧位,头向后仰,下颌抬高,纤支镜插至声门准备进入气管前,纤支镜引导下插管好监护，并且要有抢救设施及电除颤仪。操作者应熟练掌握纤支镜，对上呼吸道解剖结构清楚以尽量缩短插管的时间。在纤支镜插管过程中,应严密观察患者的心率、呼吸、血压、色及SpO2),如出现及时告知医生。插管术嘱患者不要说话,以免加重咽喉炎症;