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(1)
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[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：1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
Maxillofacial surgeon anesthesia and management experience
CHEN Li,Li Yong-rong,CHENG Xi-xiong
(Department of Anesthesiology,Sichuan Huamei Zixin Medicine Aesthetic Hospital,Chengdu 610041,Sichuan,China)
Abstract:ObjectiveTo apply nasotracheal intubation and inhalation composite general anesthesia for maxillofacial plastic surgery and to introduce perioperative management experience,improve the safety of the operation and reduce operation mortality.Methods538 maxillofacial plastic surgery patients recieved inhalation composite general anesthesia,ASA Ⅰ～Ⅱ level,age 19～58 years old,535 cases of nasotracheal intubation and three case of orotracheal intubation because of nasal intubation difficulties or other surgical reasons.Results1 case of difficult airway abandon surgery because of unsuccessful tracheal intubation.1 case of diffculty airway who received orotracheal intubation occured laryngeal edema after drawing tracheal intubation,then followed cricothyrotomy because the cricothyroid membrane puncture cannot releive the airway obstruction completely.3 cases acquired successful tracheal intubation with the assistant of bronchofiberscope. Among the cases,13 cases occured hematoma and took the airway emergency measures.ConclusionTracheal intubation inhalation composite general anesthesia is a safe technique for maxillofacial surgeon because of easy to control airway.Compared with orotracheal intubation,the nasotracheal intubation can offer more space and good stability,the tube can keep as nasopharynxair passage.Maxillofacial surgery is complicated and easy to occur severe complications such as hematoma and airway obstruction,so it is important to control the respiratory tract.
Key words:maxillofacial surgery;nasotracheal intubation and inhalation composite general anesthesia;respiratory tract control;blood loss;respiratory tract obstruction ......
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