CAJ | 학술논문

目的探讨在局部麻醉和通气导管辅助下气管支架置入术的可行性与安全性.方法回顾性分析2008年9月至2013年11月,25例恶性气管狭窄患者行局部麻醉和通气导管辅助下气管支架置入术的情况.25例患者气促评级为2～4级,其中2级3例、3级18例、4级4例.治疗过程中,预先将1根4F单弯导管通过气管狭窄段置入一侧主支气管作为通气导管,根据患者的病情设氧流量为2～4 L/min,然后在维持通气的状态下予以置入气管支架,支架释放后再撤出通气导管.术后统计并分析气管支架置入技术成功率、患者症状缓解情况及随访的相关数据.术前与术后患者的血氧饱和度(SaO2)及呼吸频率的变化情况采用配对t检验.结果在局部麻醉和通气导管辅助下气管支架置入术均获得成功,共置入气管支架25枚,其中筒状支架19枚、Y型支架6枚.置入通气导管通气后,所有患者的SaO2迅速提升至94％～97％,当气管支架输送器通过气管狭窄段时,所有患者SaO2仍可维持在92％～97％,均无呼吸困难,支架释放顺利.术后25例患者症状均得到改善,气促评级术后O级2例、1级19例、2级4例,呼吸频率及SaO2由术前的(30.0±2.1)次/min与(76.0±3.8)％改善至术后的(19.7±1.6)次/min(t=23.33,P＜0.01)与(93.0±1.7)％(t=23.50,P＜0.01),差异均有统计学意义.术后随访2～11个月,3例患者出现了支架相关并发症,其中支架断裂1例、支架再狭窄2例.结论局部麻醉下通气导管辅助下气管支架置入术是一种安全、简便并且有效的方法,值得临床推广.
목적 탐토재국부마취화통기도관보조하기관지가치입술적가행성여안전성.방법 회고성분석2008년9월지2013년11월,25례악성기관협착환자행국부마취화통기도관보조하기관지가치입술적정황.25례환자기촉평급위2～4급,기중2급3례、3급18례、4급4례.치료과정중,예선장1근4F단만도관통과기관협착단치입일측주지기관작위통기도관,근거환자적병정설양류량위2～4 L/min,연후재유지통기적상태하여이치입기관지가,지가석방후재철출통기도관.술후통계병분석기관지가치입기술성공솔、환자증상완해정황급수방적상관수거.술전여술후환자적혈양포화도(SaO2)급호흡빈솔적변화정황채용배대t검험.결과 재국부마취화통기도관보조하기관지가치입술균획득성공,공치입기관지가25매,기중통상지가19매、Y형지가6매.치입통기도관통기후,소유환자적SaO2신속제승지94％～97％,당기관지가수송기통과기관협착단시,소유환자SaO2잉가유지재92％～97％,균무호흡곤난,지가석방순리.술후25례환자증상균득도개선,기촉평급술후O급2례、1급19례、2급4례,호흡빈솔급SaO2유술전적(30.0±2.1)차/min여(76.0±3.8)％개선지술후적(19.7±1.6)차/min(t=23.33,P＜0.01)여(93.0±1.7)％(t=23.50,P＜0.01),차이균유통계학의의.술후수방2～11개월,3례환자출현료지가상관병발증,기중지가단렬1례、지가재협착2례.결론 국부마취하통기도관보조하기관지가치입술시일충안전、간편병차유효적방법,치득림상추엄.
Objective To discuss the ventilatory catheter-assisted airway stenting under local anesthesia for airway stenosis.Methods From May 2008 to January 2013,25 consecutive patients with airway stenosis underwent the treatment of ventilatory catheter-assisted airway stenting under local anesthesia.The dyspnea score was grade Ⅱ in 3 patients,grade Ⅲ in 18 patients and grade Ⅳ in 4 patients.During the treatment,a 4 F VER catheter was placed into one of the main bronchi as a ventilatory catheter for oxygen supply in advance,the oxygen flow was set at 2 to 4 L/rmin according to the patients' condition,then the airway stenting was performed,after release of the stent,the ventilatory catheter was removed smoothly.Data on technical success,clinical outcome and follow-up were collected and analyzed respectively.The paired t test was performed to compare variables before and after tracheal stenting.Results Ventilatory catheter-assisted airway stenting under local anesthesia was technically successful in all patients.A total of 25 stents were placed in 25 patients.The stents included I-shaped stents (n=19) and Y-shaped stents (n=6).After the oxygen supply,the patients' SaO2 was increased to 94％ to 97％ rapidly.When the stent introducer sheaths were passing through the stenotic site,the SaO2 could be maintained at 92％ to 97％.The improvement of the respiratory difficulty was achieved in 100％ of our patients.The hypoxia symptom was relieved immediately after stents placement,the dyspnea score decreased to grade 0 in 2 patients,to grade Ⅰ in 19 patients and to grade Ⅱ in 4 patients.Respiratory rate and SaO2 improved from (30.0±2.1) times/min and (6.0±3.8)％ before stenting to (19.7±1.6) times/min (t=23.33,P＜0.01) and (93.0± 1.7)％ (t=23.50,P＜0.01) after stenting,respectively.Through the follow-up,3 patients suffered the stent-related complications after discharge,the complications included re-stenosis (n=2) and fracture(n=1).Conclusion Ventilatory catheter-assisted airway stenting under local anesthesia can be an effective,simple and safe method for airway stenosis.