CAJ | 학술논문

目的对重度气道狭窄患者置放国产镍钛记忆合金支架的方法学进行初步评价.方法应用全身麻醉下分别采用经喉罩、气管插管或硬质气管镜的方法对2005年11月至2009年4月收入北京大坛医院呼吸科的40例难以在局部麻醉下操作的重症气道狭窄患者置入国产镍钛记忆合金气道支架.结果 40例患者根据病变部位及病变特点选择经喉罩23例,气管插管11例,硬质气管镜6例,并予全身麻醉及机械通气,共放置了42枚支架:气管支架27枚(其中覆膜支架9枚)、左主支气管支架8枚、右主支气管至右中间段支架2枚、气管至左主支气管楔形支架5枚.在全身麻醉、机械通气维持患者各项生命体征的条件下,所有病例都顺利置入,未出现并发症.支架释放后所有病例气道压力即降至正常,同时其他机械通气参数也恢复正常.大部分患者呼吸困难指数分级由Ⅳ～V级改善到0～Ⅱ级.结论对于重度气道狭窄患者,在全身麻醉下经喉罩、气管插管及硬质气管镜的方法可以顺利放置局部麻醉下难以操作的各种高难度气道支架的置放,并且安全、有效、舒适,值得在临床进一步推广.
목적 대중도기도협착환자치방국산얼태기억합금지가적방법학진행초보평개.방법 응용전신마취하분별채용경후조、기관삽관혹경질기관경적방법대2005년11월지2009년4월수입북경대단의원호흡과적40례난이재국부마취하조작적중증기도협착환자치입국산얼태기억합금기도지가.결과 40례환자근거병변부위급병변특점선택경후조23례,기관삽관11례,경질기관경6례,병여전신마취급궤계통기,공방치료42매지가:기관지가27매(기중복막지가9매)、좌주지기관지가8매、우주지기관지우중간단지가2매、기관지좌주지기관설형지가5매.재전신마취、궤계통기유지환자각항생명체정적조건하,소유병례도순리치입,미출현병발증.지가석방후소유병례기도압력즉강지정상,동시기타궤계통기삼수야회복정상.대부분환자호흡곤난지수분급유Ⅳ～V급개선도0～Ⅱ급.결론 대우중도기도협착환자,재전신마취하경후조、기관삽관급경질기관경적방법가이순리방치국부마취하난이조작적각충고난도기도지가적치방,병차안전、유효、서괄,치득재림상진일보추엄.
Objective It is more difficult and carries more risks to place airway stent under local anaesthesia for the patient with severe airway stenosis.The technique and method of domestically made recalled nitinol alloy stent implantation for severe airway stenosis was explored and evaluated.Methods By using bronchoscopy via larynx mask,trachea intubation,or rigid bronchoscope under general anaesthesia and mechanical ventilation,stents are placed in the airway of patients with severe airway stenosis for which had been difficult to performed under local anaesthesia.Results According to the various tracheobronchial lesions of patients.42 stents were successfully placed in 40 patients,via larynx mask 23 cases,trachea intubation 11 cases,and rigid bronchoscope 6 cases under general anaesthesia and mechanical ventilation.No complications happened.The recalled nitinoi alloy stents were placed in trachea 27 cases(membrane covered stent 9 cases),left primary bronchus 8 cases,right primary bronchus to medial segment 2 cases,trachea to left primary bronchus(wedge shaped stent)5 cases respectively.The airway pressure decreased to normal level and other ventilator parameters also recovered after stents were placed.In most patients,the dyspnea index was improved immediately and the scores decreased from grades IV.V to grades 0-Ⅱ.with higher scores indicating worse dyspnea.Conclusion For patients with severe airway stenosis,it is safer,effective and more comfortable to place the stent via larynx mask,trachea intubation,or rigid bronchoscope under general anaesthesia and mechanical ventilation compared to local anaesthesia and is worth spread and popularization in the future.