螺旋ct重建成像分析在气管狭窄患者麻醉前评价中的应用.doc

螺旋CT重建成像分析在气管狭窄患者麻醉中的应用 谢书奇, 张晓庆, 郑少强 (同济大学附属同济医院麻醉科,上海 200065) 【摘要】目的 探CT重建成像分析在气管狭窄患者麻醉中的应用价值。方法 选择拟行气管插管全身麻醉X线胸片示气管受压狭窄的甲状腺疾病患者13例。术前患者从舌骨上缘至颈7下缘行螺旋CT扫描。选择CT模拟支气管镜、多平面重建技术重建图像。测量气管受压狭窄段的长度；气管受压狭窄段末端距环状软骨的距离；气管受压狭窄最严重处的直径、横截面积；未受压处气管的直径、横截面积。按Cotton(1989) 分级标准[1]评定患者的气管狭窄程度。气管狭窄程度Ⅰ级的患者，予常规诱导、直接喉镜气管插管，术后患者呼吸恢复后拔除气管导管；气管狭窄程度Ⅱ～Ⅲ0.05mg、丙泊酚1～2mg.kg-1镇静、镇痛，表面麻醉下经纤维支气管镜气管插管，术后带气管导管入ICU治疗。结果 13例患者中，气管狭窄程度Ⅰ级10例，气管狭窄程度Ⅱ级3例。气管狭窄最严重处直径3.4～9.3 mm，平均（6.5±1.3）mm；气管狭窄最严重处横截面积0.82～123 cm2，平均（1.03±0.8 ）cm2；狭窄段长度2.8～6.0cm，平均（4.5±0.8）cm；气管狭窄段末端距环状软骨5.0～7.1 cm，平均（6.1±0.5）cm。13例患者均成功完成麻醉诱导插管，且首次插管成功率为100%。术后，10例患者呼吸恢复后拔除气管导管，3例患者入ICU治疗24～48h后拔除气管导管。13例患者均康复出院。结论 麻醉前行螺旋CT气道重建成像分析，对指导气管受压狭窄患者的围术期气道管理，提高该类患者麻醉的质量与安全性有重要意义。 【关键词】气管狭窄；麻醉；气管插管；计算机断层摄影；三维重建 【中途分类号】 【文献标志码】 【文章编号】 The application of tracheal reconstruction by spiral CT in the anesthesia of the patients with tracheal stenosis XIE Shuqi,ZHANG Xiaoqing,Zheng Shaoqiang (Dept .of Anesthesiology , Tong Ji Hospital, Shanghai 200065,China.) 【Abstract】Objective To evaluate the application of tracheal reconstruction by spiral CT in the anesthesia of the patients with tracheal stenosis. Method 13 patients planned for general anaesthesia with tracheal intubation for their thyroid disease accompanied by tracheal stenosis revealed by chest roentgenogram were selected in this study. Spiral CT scanned from the level of the upper edge of the hyoid bone to the seventh cervical vertebra in these patients. Multiplanar reconstructions were performed in each of those patients. The length of the stenosed segment of the trachea; the distance from the distal end of the stenosed segment of the tracheal to the cricoid cartilage; the diameter and the cross section area of the most severely stenosed segment of the trachea; the diameter and the cross section area of the non-stenosed part of the trachea were measured. The degree of