CAJ | 학술논문

目的探讨全身麻醉下气管内支架置入术治疗恶性气管、主支气管狭窄的可行性和安全性.方法 18例恶性肿瘤引起的气管、主支气管狭窄患者(气管腺癌1例、食管癌9例、肺癌纵隔淋巴结转移癌7例、甲状腺癌术后纵隔内淋巴结转移1例),术前均行64排CT扫描及气道重组.其中气管狭窄5例,右支气管狭窄1例,气管合并左或右支气管狭窄7例,气管、左右支气管均狭窄5例；气管狭窄51％～70％7例,71％～90％ 11例.所有患者均为重度呼吸困难,根据美国麻醉师协会(ASA)评分评估Ⅳ级17例、Ⅲ级1例.患者均经全身麻醉后,在DSA监视下,经气管插管连接管的吸痰孔进入,进行气管支架置入术.手术全程监测血压、心电图、经皮血氧饱和度( SaO2)、呼吸频率.术后观察患者呼吸困难缓解情况,麻醉及手术相关重要并发症,评价全麻效果(舒适度评分),并进行气管支架置入操作顺利度综合评价.对患者在麻醉过程不同时间的血压、心率、呼吸、SaO2以及手术前后动脉血气监测结果采用t检验进行比较.结果 18例均成功置入支架,术后呼吸困难均明显缓解,7例出现轻度痰中带血、1例痰液涌出堵住支架,对症处理后好转,手术均顺利,未出现其他麻醉及手术相关严重并发症.气管支架置入操作顺利度综合评分9 ～11分17例,6～8分1例；手术过程中患者均配合良好；舒适度评价优16例,良2例.呼吸频率及心率在麻醉苏醒后[分别为(18.6±1.4)和(73.2±7.6)次/min]明显低于麻醉前[分别为(37.1±2.8)和(106.5 ±14.2)次/min](t值分别为17.81、3.80,P值均＜0.01),SaO2在术中[(91.2±1.8)％]高于术前[(76.3±8.6)％](t=2.06,P＜0.01).麻醉苏醒后患者SaO2[(94.5±4.3)％]较术前明显升高(=2.26,P＜0.01)；血压在麻醉苏醒后较麻醉前无明显变化(P＞0.05).手术综合评价均良好.结论恶性气管狭窄在充分评估后,全身麻醉下进行气管支架置入术是安全可行的. 目的探討全身痳醉下氣管內支架置入術治療噁性氣管、主支氣管狹窄的可行性和安全性.方法 18例噁性腫瘤引起的氣管、主支氣管狹窄患者(氣管腺癌1例、食管癌9例、肺癌縱隔淋巴結轉移癌7例、甲狀腺癌術後縱隔內淋巴結轉移1例),術前均行64排CT掃描及氣道重組.其中氣管狹窄5例,右支氣管狹窄1例,氣管閤併左或右支氣管狹窄7例,氣管、左右支氣管均狹窄5例；氣管狹窄51％～70％7例,71％～90％ 11例.所有患者均為重度呼吸睏難,根據美國痳醉師協會(ASA)評分評估Ⅳ級17例、Ⅲ級1例.患者均經全身痳醉後,在DSA鑑視下,經氣管插管連接管的吸痰孔進入,進行氣管支架置入術.手術全程鑑測血壓、心電圖、經皮血氧飽和度( SaO2)、呼吸頻率.術後觀察患者呼吸睏難緩解情況,痳醉及手術相關重要併髮癥,評價全痳效果(舒適度評分),併進行氣管支架置入操作順利度綜閤評價.對患者在痳醉過程不同時間的血壓、心率、呼吸、SaO2以及手術前後動脈血氣鑑測結果採用t檢驗進行比較.結果 18例均成功置入支架,術後呼吸睏難均明顯緩解,7例齣現輕度痰中帶血、1例痰液湧齣堵住支架,對癥處理後好轉,手術均順利,未齣現其他痳醉及手術相關嚴重併髮癥.氣管支架置入操作順利度綜閤評分9 ～11分17例,6～8分1例；手術過程中患者均配閤良好；舒適度評價優16例,良2例.呼吸頻率及心率在痳醉囌醒後[分彆為(18.6±1.4)和(73.2±7.6)次/min]明顯低于痳醉前[分彆為(37.1±2.8)和(106.5 ±14.2)次/min](t值分彆為17.81、3.80,P值均＜0.01),SaO2在術中[(91.2±1.8)％]高于術前[(76.3±8.6)％](t=2.06,P＜0.01).痳醉囌醒後患者SaO2[(94.5±4.3)％]較術前明顯升高(=2.26,P＜0.01)；血壓在痳醉囌醒後較痳醉前無明顯變化(P＞0.05).手術綜閤評價均良好.結論噁性氣管狹窄在充分評估後,全身痳醉下進行氣管支架置入術是安全可行的.
목적 탐토전신마취하기관내지가치입술치료악성기관、주지기관협착적가행성화안전성.방법 18례악성종류인기적기관、주지기관협착환자(기관선암1례、식관암9례、폐암종격림파결전이암7례、갑상선암술후종격내림파결전이1례),술전균행64배CT소묘급기도중조.기중기관협착5례,우지기관협착1례,기관합병좌혹우지기관협착7례,기관、좌우지기관균협착5례；기관협착51％～70％7례,71％～90％ 11례.소유환자균위중도호흡곤난,근거미국마취사협회(ASA)평분평고Ⅳ급17례、Ⅲ급1례.환자균경전신마취후,재DSA감시하,경기관삽관련접관적흡담공진입,진행기관지가치입술.수술전정감측혈압、심전도、경피혈양포화도( SaO2)、호흡빈솔.술후관찰환자호흡곤난완해정황,마취급수술상관중요병발증,평개전마효과(서괄도평분),병진행기관지가치입조작순리도종합평개.대환자재마취과정불동시간적혈압、심솔、호흡、SaO2이급수술전후동맥혈기감측결과채용t검험진행비교.결과 18례균성공치입지가,술후호흡곤난균명현완해,7례출현경도담중대혈、1례담액용출도주지가,대증처리후호전,수술균순리,미출현기타마취급수술상관엄중병발증.기관지가치입조작순리도종합평분9 ～11분17례,6～8분1례；수술과정중환자균배합량호；서괄도평개우16례,량2례.호흡빈솔급심솔재마취소성후[분별위(18.6±1.4)화(73.2±7.6)차/min]명현저우마취전[분별위(37.1±2.8)화(106.5 ±14.2)차/min](t치분별위17.81、3.80,P치균＜0.01),SaO2재술중[(91.2±1.8)％]고우술전[(76.3±8.6)％](t=2.06,P＜0.01).마취소성후환자SaO2[(94.5±4.3)％]교술전명현승고(=2.26,P＜0.01)；혈압재마취소성후교마취전무명현변화(P＞0.05).수술종합평개균량호.결론 악성기관협착재충분평고후,전신마취하진행기관지가치입술시안전가행적.
Objective To evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk(5 patients),in right main bronchus( 1 patient),in trachea and left main bronchus (4 patients),in trachea and right main bronchus (3 patients),in main tracheal trunk and bilateral main bronchus(5 patients).The degree of stenosis was rated 51％ to 70％ in 7 cases,71％ to 90％ in 11 cases.All patients,17 patients of ASA grade 1V and 1 patient of grade Ⅲ,presented with severe dyspnea. Under general anaesthesia,implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance.The NBP,ECG,RR,SaO2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure,relief of dyspnea,complications related to anesthesia and operation were recorded. Results The success rate of stent placement was 18/18,and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 cases.The stent was obstructed by sputum in 1 case,and the patient was treated with medication.There were no severe complications.The operative course were rated 11 to 9 in 17 cases,and 6 to 8 in 1 case.All 18 patients were cooperative during the procedure.Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable.Respiratory rate (RR) and heart rate (HR) decreased in all patients after the operation [ ( 37.1 ± 2.8 )/min and ( 106.5 ± 14.2 ) bpm before the operation respectively,( 18.6 ± 1.4)/min and ( 73.2 ± 7.6) bpm after the operation respectively ],t =17.81 and 3.80,P ＜ 0.01.Pulse oxygen saturation ( SaO2 ) during the operation [ ( 91.2 ± 1.8 ) ％ ]increased [ (76.3 ± 8.6 )％ before the operation ] and increased further after the operation [ (94.5 ±4.3 ) ％ ],t =2.06 and 2.26,P ＜ 0.01.Blood pressure (BP) showed no changes throughout the operation (P ＞ 0.05 ).The conprehensive assessment of operation were favorable in all patients. Conclusion With careful preoperative evaluation and planning, tracheal stent implantation under general anaesthesia in patients with malignant tracheal stenosis is feasible and safe.