CAJ | 학술논문

目的：探讨经口寰枢椎复位钢板（TARP）内固定术后经鼻气管导管拔除的指针和方法。方法187例行 TARP 内固定手术成年患者，术前均经鼻腔放置加强型气管导管，术毕留置气管导管并口腔填塞纱条压迫止血。术后第1天起每日进行拔管指针评估，在神志清楚、咳嗽能力及呼吸循环功能正常、伤口无裂开出血前提下，依据气囊漏气试验（CLT）指导拔管，CLT 阴性者即行常规拔管。若术后第3天 CLT 仍阳性则在纤维支气管镜辅助下（FBA）试拔管。记录拔管后喘鸣和24 h 内再插管率，分析该拔管方法的优点和安全性。结果术后第1、2天常规拔管者分别为69、82例。第3天常规拔管15例，其余21例采用 FBA 试拔管，其中11例拔管成功，10例试拔管后出现喘鸣和呼吸困难而留管至第4天。第4天6例常规拔管，4例 FBA 拔管成功。第1～4天常规拔管者中喘鸣发生例数分别为4、6、1、1例（共12例），其中1例于拔管后4 h 被迫再次插管。FBA 拔管成功者中没有出现拔管后喘鸣和需再插管。结论严格掌握拔管指针和拔管方法，TARP 内固定术后患者大多能在术后2 d 内顺利拔除气管导管。CLT 结合 FBA 拔管安全有效，能避免拔管后24 h 内再插管的发生。
목적：탐토경구환추추복위강판（TARP）내고정술후경비기관도관발제적지침화방법。방법187례행 TARP 내고정수술성년환자，술전균경비강방치가강형기관도관，술필류치기관도관병구강전새사조압박지혈。술후제1천기매일진행발관지침평고，재신지청초、해수능력급호흡순배공능정상、상구무렬개출혈전제하，의거기낭루기시험（CLT）지도발관，CLT 음성자즉행상규발관。약술후제3천 CLT 잉양성칙재섬유지기관경보조하（FBA）시발관。기록발관후천명화24 h 내재삽관솔，분석해발관방법적우점화안전성。결과술후제1、2천상규발관자분별위69、82례。제3천상규발관15례，기여21례채용 FBA 시발관，기중11례발관성공，10례시발관후출현천명화호흡곤난이류관지제4천。제4천6례상규발관，4례 FBA 발관성공。제1～4천상규발관자중천명발생례수분별위4、6、1、1례（공12례），기중1례우발관후4 h 피박재차삽관。FBA 발관성공자중몰유출현발관후천명화수재삽관。결론엄격장악발관지침화발관방법，TARP 내고정술후환자대다능재술후2 d 내순리발제기관도관。CLT 결합 FBA 발관안전유효，능피면발관후24 h 내재삽관적발생。
Objective To explore the indications and methods of nasotracheal extubation in patients undergoing tran-soral atlantoaxial reduction plate(TARP)internal fixation surgery.Methods One hundred and eighty seven adult patients scheduled for TARP internal fixation surgery were enrolled in this prospective study.All patients were naso-tracheal intubated preoperatively.Nasotracheal tube(NTT)was kept and oral cavity was filled with gauze for hemo-stasis postoperatively.Since the first postoperative day,each patient was evaluated daily whether NTT could be extu-bated.Under the precondition of that consciousness,expectoration capacity,respiratory and circulatory function were normal,and pharyngeal wound dehiscence or hemorrhage were not noticed,readiness for extubation was based on the qualitative cuff-leak test(CLT),and NTT was extubated routinely in patients with negative CLT.From the third day after surgery,extubation with fiber bronchoscope assistance(FBA)was attempted in patients with positive CLT.After extubation,stridor and reintubation within 24 hours were recorded and analyzed.Results 69 cases,82 cases were extubated routinely on the first,second postoperative day respectively.On the third day after surgery,fifteen patients were extubated routinely and eleven patients were extubated successfully with FBA and ten patients were kept intuba-ted for emergence of stridor and dyspnea during the extubation with FBA.On the fourth postoperative day,six pa-tients were extubated routinely and four patients were extubated successfully with FBA.Among the patients that could be extubated routinely,4 patients,6 patients,1 patient and 1 patient developed stridor on the first,second,third and fourth postoperative day,respectively,and 1 patient needed reintubation at 4h after extubation.No stridor and reintu-bations occurred in patients extubated successfully with FBA.Conclusions Provided indications and methods for ex-tubation are executed strictly,most NTT can be extubated safely in patients undergoing TARP internal fixation surgery within two postoperative days.The method of extubation using CLT and FBA is safe and effective and can avoid pos-textubation reintubation.