颌面头颈外科术后气道管理困难的手术因素分析

doi:10.19438/j.cjoms.2018.02.011

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (2): 153-156.doi: 10.19438/j.cjoms.2018.02.011

颌面头颈外科术后气道管理困难的手术因素分析

杨雅琼, 严佳, 黄燕

上海交通大学医学院附属第九人民医院麻醉科, 上海交通大学中国医院发展研究院学科建设研究所,上海 200011;

收稿日期:2017-10-23 修回日期:2018-01-11 出版日期:2018-03-20 发布日期:2018-04-08
通讯作者: 黄燕,E-mail：huangyan606@126.com
作者简介:杨雅琼（1985-）,女,硕士,主治医师,E-mail：yangyaqiong228@163.com
基金资助:
上海市优秀学术带头人计划（16XD1401800）; 上海交通大学医学院医学教育研究项目（YB170711）

Analysis of procedure factors contributing to postoperative difficult airway management of head neck and maxillofacial surgery

YANG Ya-qiong, YAN Jia, HUANG Yan

Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University, China Hospital Development Institute. Shanghai 200011, China;

Received:2017-10-23 Revised:2018-01-11 Online:2018-03-20 Published:2018-04-08

摘要/Abstract

摘要： 目的: 探讨影响颌面头颈外科手术术后发生气道管理困难的手术因素。 方法: 对我院2015年1月—12月间的180例颌面头颈外科术后带人工气道入SICU患者进行回顾分析。根据手术类型分为3组,即肿瘤切除术组（60例）、先天性畸形矫正术组（60例）和创伤手术组（60例）。使用SPSS 13.0软件包对各组围术期资料进行χ²检验和t检验,筛选差异指标。 结果: 肿瘤切除术组手术和麻醉时间较另外2组长（P<0.05）,需行清醒气管插管比例高（P<0.05）,术中出血量多（P<0.05）,术后带管时间较长（P<0.05）。创伤手术组镇静不足、躁动发生率较另外2组高（P<0.05）。 结论: 颌面头颈外科手术患者因局部解剖结构改变,出血、水肿压迫气道等原因,气道梗阻风险较高,给予适度的镇静、镇痛,保留气管插管并延迟拔管,可以避免发生严重并发症。

关键词: 术后管理, SICU, 拔管, 气道梗阻

Abstract: PURPOSE: To summarize the experience in postoperative difficult airway management of head neck and maxillofacial surgery. METHODS: Between January 2015 and December 2015, 180 patients undergoing head neck and maxillofacial surgery with artificial airway in SICU were analyzed retrospectively. The patients were divided into 3 groups according to the type of the operation: tumor resection group (60 cases), congenital malformation correction group (60 cases) and trauma group (60 cases). SPSS13.0 software package was used for perioperative statistical analysis. RESULTS: The operation and anesthesia time, the ratio of awake tracheal intubation and the amount of bleeding during operation in the tumor resection group were significantly higher than those in the other two groups (P<0.05), the postoperative tube time was also significantly longer (P<0.05) in the tumor resection group. The incidence of sedation and restlessness was highest in the trauma operation group (P<0.05). CONCLUSIONS: Head neck and maxillofacial surgery often has airway obstruction due to local anatomical structure change, hemorrhage and edema. Use of sedation and analgesia drugs, retained tracheal intubation and delayed extubation can avoid the occurrence of serious complications.

Key words: Postoperative care, SICU, Extubation, Airway obstruction

中图分类号:

R782.05.4

杨雅琼, 严佳, 黄燕. 颌面头颈外科术后气道管理困难的手术因素分析[J]. 中国口腔颌面外科杂志, 2018, 16(2): 153-156.

YANG Ya-qiong, YAN Jia, HUANG Yan. Analysis of procedure factors contributing to postoperative difficult airway management of head neck and maxillofacial surgery[J]. China J Oral Maxillofac Surg, 2018, 16(2): 153-156.

参考文献

[1] Apfelbaum JL, Hagberg CA, Caplan RA, et al.Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway[J]. Anesthesiology, 2013, 118(2): 251-270.
[2] Peterson GN, Domino KB, Caplan RA, et al.Management of the difficult airway: a closed claims analysis[J]. Anesthesiology, 2005, 103(1): 33-39.
[3] 侯静, 许媛. 头颈-口腔-颌面外科术后气道管理[J]. 中国临床保健杂志, 2011, 14(3): 252-254.
[4] Crosher R, Baldie C, Mitchell R.Selective use of tracheostomy in surgery for head and neck cancer: an audit[J]. Br J Oral Maxillofac Surg, 1997, 35(1): 43-45.
[5] Mishra S, Bhatnagar S, Jha RR, et al.Airway management of patients undergoing oral cancer surgery: a retrospective study[J]. Eur J Anaesthesiol, 2005, 22(7): 510-514.
[6] Kruse-Lösler B, Langer E, Reich A, et al.Score system for elective tracheotomy in major head and neck tumour surgery[J]. Acta Anaesthesiol Scand, 2005, 49(5): 654-659.
[7] 朱莹, 徐辉, 朱也森, 等. 影响颌面肿瘤手术后气道管理的手术因素分析[J]. 组织工程与重建外科, 2011, 7(5): 286-289, 294.
[8] Cladis F, Kumar A, Grunwaldt L, et al.Pierre Robin Sequence: a perioperative review[J]. Anesth Analg, 2014, 119(2): 400-412.
[9] Gothwal S, Nayan S, Kumar J.Crouzon syndrome with bony upper airway obstruction: case report and review literature[J]. Fetal Pediatr Pathol, 2014, 33(4): 199-201.
[10] Ito H, Sobue K, So MH, et al.Postextubation airway management with nasal continuous positive airway pressure in a child with Down syndrome[J]. J Anesth, 2006, 20(2): 106-108.
[11] Bucx MJ, Grolman W, Kruisinga FH, et al.The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome[J]. Paediatr Anaesth, 2003, 13(6): 530-533.
[12] 陈洁, 刘和平, 姜虹, 等. 口腔正颌手术的麻醉进展[J]. 临床麻醉学杂志, 2007, 23(4): 350-352.
[13] 艾莉, 齐日迈. 重度口腔颌面部外伤并发窒息38例救治体会[J]. 中外健康文摘, 2011, 8(48): 114-115.
[14] 祝祎, 张宏. 小儿颞颌关节强直手术的麻醉[J]. 临床麻醉学杂志, 2001, 17(6): 344.
[15] 王瑛, 王蕾. 严重口腔颌面部创伤的急救与麻醉处理[J]. 内蒙古医学杂志, 2009, 41(9): 1070-1072.
[16] Kheterpal S, Healy D, Aziz M F, et al.Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group[J]. Anesthesiology, 2013, 119(6): 1360-1369.

颌面头颈外科术后气道管理困难的手术因素分析

Analysis of procedure factors contributing to postoperative difficult airway management of head neck and maxillofacial surgery

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

本文评价

[1]	王烨, 黄慧敏, 王圆, 吕翔. 不同体位对正颌术后气管拔管安全性及应激反应的影响[J]. 中国口腔颌面外科杂志, 2024, 22(2): 181-185.
[2]	施金雅, 李静洁, 刘锦星, 仇琳. 阻塞性睡眠呼吸暂停综合征患儿全麻术后拔管时间的影响因素分析[J]. 中国口腔颌面外科杂志, 2023, 21(2): 180-185.