经口寰枢椎术后经鼻气管导管拔除时机与方法.docVIP

经口寰枢椎术后经鼻气管导管拔除时机与方法 　　【摘要】目的：探讨经口寰枢椎术后经鼻气管导管拔除的时机与方法。方法：选择择期经口寰枢椎手术患者50例，其中，男性28例，女性22例，年龄7～63岁。术前经鼻放置加强型气管导管，全麻下经口完成寰枢椎手术，术毕留置气管导管并口腔填塞纱条压迫止血。术后每日进行评估，符合拔管适应证者即按照特定的拔管方法尽早进行拔管，并记录拔管后并发症。结果：50例患者在术后3天内均顺利拔除经鼻留置的气管导管，其中术后第1、2、3天拔除者分别有12、33、5例，未发生拔管并发症。结论：严格掌握拔管适应证，经口寰枢椎术后患者都能在术后3天内安全顺利地拔除气管导管，无须等待至口咽部伤口愈合。 　　【关键词】经口寰枢椎术后；气管导管；拔除 　　【中图分类号】R687.3【文献标识码】B【文章编号】1008-6455（2011）04-0310-02 　　The timing and method of pulling out trans-nose tracheal tube after trans-oral atlantoaxialsurgery 　　Dai Jianqiang Yin Qingshui Gu Zhengtao et al 　　【Abstract】Objective:To explore the timing and method of pulling out trans-nose tracheal tube after trans-oral atlantoaxial surgery. Methods:Fifty patients scheduled for trans-oral atlantoaxial surgery were evaluated, including 28 male and 22 female, between 7 and 63 years old, averaged 45. All patients were inserted strengthened tracheal tube by nose preoperatively. Postoperatively, tracheal tube was kept and evaluated everyday to decide it could be pulled out or not. Tracheal tube was pulled out as soon as patient match to the certification of pulling out. Complications of pulling out tracheal tube were recorded. Results:The tracheal tube was pulled out in 12, 33, 5 patients onthe first, second and third day after surgery respectively. there are no patient suffering from complications of pulling out. Conclusion:Trans-nose tracheal tube after trans-oral atlantoaxial surgery could be pulled out safely and successfully without any complications by controlling strictly the certification of pulling out. 　　【Key words】transoral atlantoaxial surgery; tracheal tub; Pull out 　　经口入路可为颅脊交界区和寰枢椎腹侧病变提供直接路径和安全显露，可有效治疗多种寰枢椎疾患[1]，但此类手术因其位置深、时间长、操作困难，术后组织肿胀明显，且患??颈椎活动明显受限，术后气道的维护和导管的安全拔除至关重要。传统的拔管时间是需等到口咽部伤口愈合和水肿消除[2]，但随着留置气管导管时间的延长，势必会增加肺部并发症的发生，为此我们通过临床研究，探讨经口寰枢椎术后经鼻气管导管拔除的时机与方法。 　　1 资料与方法 　　1.1 一般资料：选择择期经口寰枢椎手术患者50例，其中，男性28例，女性22例，年龄最小7岁，最大63岁，平均45岁。术前经鼻腔插入胃管，麻醉诱导后经另侧鼻腔插入加强型气管导管，在全身麻醉下经口咽入路完成手术，术后患者初醒评估神经功能后口腔填塞硫酸镁和碘纺纱条各一根，并留置经鼻气管导管回监护病房。 　　1