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目的:探讨肿瘤累及颈段气管患者术前气道处理及术后窒息预防措施,为手术的安全性提供临床依据。方法:回顾性分析35例不同程度的肿瘤累及颈段气管患者的临床资料,根据患者就诊时是否强迫体位、呼吸困难程度、复发肿瘤范围等情况,选择常规气管插管后麻醉、表面麻醉后清醒状态下可视喉镜辅助下插管麻醉、术前气管切开插管麻醉、横断气管插管麻醉以及体外循环技术的麻醉方法。术后根据手术中气管受累程度和处理方式以及患者的全身状况选择气管切开或造瘘。结果:35例患者均成功实施全身麻醉,其中17例术前无强迫体位及呼吸困难的患者均顺利麻醉插管;术后3例进行了预防性气管切开。16例伴有强迫体位的非复发肿瘤患者中,15例术前均先吸入表面麻醉后在清醒状态下经可视喉镜辅助成功行麻醉插管,1例无法麻醉插管也无法急诊气管切开的患者利用体外循环技术完成麻醉;本组患者术后均行预防性气管切开或造瘘。2例伴有强迫体位的复发肿瘤患者,术前气管插管未能成功,1例紧急横断气管再麻醉插管,1例术前紧急气管切开插管麻醉成功,2例均术后气管造瘘。所有患者术后均未出现大出血、窒息、心血管意外等严重并发症。结论:肿瘤累及颈段气管患者术前气道处理及术后是否行气管切开或造瘘预防窒息需根据累及颈段气管肿瘤的性质、是否为复发肿瘤、气管受累及的程度以及是否合并OSAHS来决定。只有综合考虑影响气道的各种因素,采取有效的方法,才能保证手术的安全性。
OBJECTIVE: To investigate the preoperative airway management and prevention of postoperative asphyxia in patients with tumor involving the cervical trachea and provide clinical evidence for the safety of the operation. Methods: The clinical data of 35 patients with different degrees of tumor involving the cervical trachea were retrospectively analyzed. According to whether the patient had forced posture, difficulty in breathing, or the extent of recurrent tumors during the treatment, the patients were selected after routine tracheal intubation anesthesia and after surface anesthesia. Under visual state laryngoscope-assisted intubation anesthesia, preoperative tracheotomy intubation anesthesia, transverse intubation anesthesia, and anesthesia for extracorporeal circulation techniques. Postoperative tracheotomy or ostomy was selected based on the degree of tracheal involvement and treatment and the general condition of the patient. RESULTS: All the 35 patients were successfully performed general anesthesia. Among them, 17 patients without forced posture and dyspnea before surgery were all successfully intubated; 3 patients underwent prophylactic tracheotomy. Of the 16 non-recurrent tumor patients with forced position, 15 patients were preoperatively inhaled with topical anesthesia and visually assisted by visual laryngoscopy under an awake condition. One patient could not be anesthetized and intubation could not be performed urgently. The open patients completed anesthesia using extracorporeal circulation technology; this group of patients underwent prophylactic tracheotomy or ostomy. Two patients with recurrent tumors with forced postures, preoperative tracheal intubation was not successful, 1 patient had an emergency tracheal tracheal anesthesia and intubation, 1 patient had an anesthetic for emergency tracheotomy and intubation before surgery, and 2 patients had postoperative tracheal reconstruction. Hey. All patients had no major complications such as major bleeding, asphyxia, or cardiovascular accident. Conclusion: Preoperative anterior airway management in patients with tumor involving the cervical trachea and tracheotomy or postoperative tracheostomy prevention should be based on the nature of the involvement of the neck tracheal tumor, whether it is a recurrent tumor, the degree of involvement of the trachea, and whether or not the OSAHS is combined. To decide. Only comprehensive consideration of various factors affecting the airway and effective methods can ensure the safety of the operation.