2008年中華醫(yī)學(xué)會全國麻醉學(xué)術(shù)年會論文集.麻醉相關(guān)新技術(shù)新業(yè)務(wù)進展(161頁).pdf
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2008 年中華醫(yī)學(xué)會全國麻醉學(xué)術(shù)年會
1
·麻醉相關(guān)新技術(shù)新業(yè)務(wù)進展·
CTrach 光導(dǎo)纖維可視性氣管插管型喉罩在面頸瘢痕攣縮患者中的應(yīng)用
中國醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 整形外科醫(yī)院麻醉科(北京，100144)
楊冬，鄧曉明，佟世義，劉具會，隋靜湖，張雁鳴，劉建華，魏靈欣，胥琨琳
摘要：目的 評價 CTrach 光導(dǎo)纖維可視性氣管插管型喉罩(CTrach 喉罩)在面頸瘢痕攣縮導(dǎo)
致的預(yù)測困難氣道處理中應(yīng)用的可行性。 方法 擇期在全麻下行面頸瘢痕整形手術(shù)的預(yù)測困難氣道
患者 33 例，麻醉誘導(dǎo)后，置入 CTrach喉罩，連接顯示器，在直視下尋找聲門，進而直視氣管插管。
記錄 CTrach喉罩置入、氣管插管、CTrach 喉罩退出的次數(shù)、時間及成功率，顯示器上所見聲門的
情況以及為尋找聲門所采用的手法，并記錄麻醉誘導(dǎo)前、后，置入 CTrach 喉罩后即刻、插入氣管
導(dǎo)管后即刻及退出 CTrach 喉罩后即刻的血壓和心率變化。結(jié)果 33 例患者均成功置入 CTrach 喉
罩，其中 4 例第 2 次成功置入。10 例顯示器上直視全部聲門，8 例和 15 例分別在顯示器上見到部
分聲門或不見聲門，調(diào)整后獲得滿意圖像。經(jīng) CTrach 喉罩27 例首次氣管插管成功，6 例第2 次插
入成功。操作過程中血流動力學(xué)改變較輕。結(jié)論 Ctrach喉罩置入簡單、圖象清晰、直視下氣管插
管成功率高，是解決面頸瘢痕攣縮導(dǎo)致的困難氣管插管的有效方法之一。
關(guān)鍵詞：喉面罩；困難氣道；插管法,氣管內(nèi)
中圖分類號：R614 文獻標識碼：A 文章編號：
Use of the fibreoptic intubating LMA CTrachTM
in faciocervical scar contracture patients
YANG Dong, DENG Xiao-ming, TONG Shi-yi, LIU Ju-hui, SUI Jing-hu, ZHANG Yan-ming, LIU Jian-hua,WEI Ling-xin, XU Kun-lin
Department of Anesthesiology，Plastic Surgery Hospital，CAMS and PUMC，Beijing 100144，China
Corresponding author: DENG Xiao-ming Tel: 010-88703937, E-mail: dengxiaoming2003@sina.com
ABSTRACT: Objective To evaluate the feasibility of the fibreoptic intubating LMA CTrachTM
(CTrach) in anticipated difficult airway caused by faciocervical scar contracture. Methods 33 patients,undergoing selective faciocervical scar plastic surgery and requiring general anesthesia. After anesthesia
induction, the CTrach was inserted, the viewer was attached, which allows fibreoptic visualization of the
larynx before and during passage of the tracheal tube through the vocal cords. The time and the success
rates of CTrach insertion, tracheal intubation and CTrach removal were recorded. The view of glottis on
viewer and adjusting manoeuvres for improving the laryngeal view were recorded. Noninvasive blood
pressure and heart rate were recorded before and after anesthesia induction, at CTrach insertion, at
intubation, at CTrach removal. Results The CTrach was inserted successfully in all patients. Among of
these, 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, and
partial view or no view of glottis were shown in 8 and 15 patients, respectively， the good view of glottis
was able to achieved by adjusting manoeuvres, Tracheal intubation via the CTrach was successful in 27
patients at the first attempt, in 6 patients at the second attempt. Hemodynamic changes during the
performance with the CTrach were minimal. Conclusions The CTrach can be inserted easily, the view
is clear, and there is a high success rate of tracheal intubation with the CTrach. It is one of effective means
to solve difficult intubation caused by faciocervical scar contracture.
Key words: Laryngeal mask airway; Difficult airway; Intubation, endotracheal
2008 年中華醫(yī)學(xué)會全國麻醉學(xué)術(shù)年會
2
CTrach 光導(dǎo)纖維可視性氣管插管型喉罩 (CTrach 喉罩) 是在Fastrach 氣管插管型喉罩 (Fastrach
喉罩)的基礎(chǔ)上，在喉罩內(nèi)增加了內(nèi)置性光導(dǎo)纖維束，其近端通過磁性接頭與顯示器相連，遠端開
口于會厭提升板的下方。將 CTrach 喉罩置入口內(nèi)后，連接顯示器，可以在直視下尋找聲門及直視
下完成氣管插管。研究表明，在正常氣道患者，經(jīng) CTrach喉罩引導(dǎo)氣管插管的成功率在 96%以上
[1、2]
，但在面頸瘢痕攣縮導(dǎo)致的困難氣管插管患者的應(yīng)用尚無報道。本研究探討 CTrach 喉罩在面頸
瘢痕攣縮導(dǎo)致的預(yù)測困難氣管插管患者應(yīng)用的可行性。
對象和方法
對象 共 33例 ASAⅠ級，擇期全麻下行面頸瘢痕整形手術(shù)的患者，至少具有一項符合困難氣
道標準(甲頦距離<6cm；張口度<3cm；Mallampati 分級Ⅲ級以上) 。牙齒松動、有胃食道反流危
險的患者排除本研究。
準備 根據(jù)患者的體重選擇合適型號的 CTrach 喉罩，3 號、4 號和5號 CTrach 喉罩分別適用于
30～50kg、50～70kg 和 70kg 以上的患者 ......
1
·麻醉相關(guān)新技術(shù)新業(yè)務(wù)進展·
CTrach 光導(dǎo)纖維可視性氣管插管型喉罩在面頸瘢痕攣縮患者中的應(yīng)用
中國醫(yī)學(xué)科學(xué)院 北京協(xié)和醫(yī)學(xué)院 整形外科醫(yī)院麻醉科(北京，100144)
楊冬，鄧曉明，佟世義，劉具會，隋靜湖，張雁鳴，劉建華，魏靈欣，胥琨琳
摘要：目的 評價 CTrach 光導(dǎo)纖維可視性氣管插管型喉罩(CTrach 喉罩)在面頸瘢痕攣縮導(dǎo)
致的預(yù)測困難氣道處理中應(yīng)用的可行性。 方法 擇期在全麻下行面頸瘢痕整形手術(shù)的預(yù)測困難氣道
患者 33 例，麻醉誘導(dǎo)后，置入 CTrach喉罩，連接顯示器，在直視下尋找聲門，進而直視氣管插管。
記錄 CTrach喉罩置入、氣管插管、CTrach 喉罩退出的次數(shù)、時間及成功率，顯示器上所見聲門的
情況以及為尋找聲門所采用的手法，并記錄麻醉誘導(dǎo)前、后，置入 CTrach 喉罩后即刻、插入氣管
導(dǎo)管后即刻及退出 CTrach 喉罩后即刻的血壓和心率變化。結(jié)果 33 例患者均成功置入 CTrach 喉
罩，其中 4 例第 2 次成功置入。10 例顯示器上直視全部聲門，8 例和 15 例分別在顯示器上見到部
分聲門或不見聲門，調(diào)整后獲得滿意圖像。經(jīng) CTrach 喉罩27 例首次氣管插管成功，6 例第2 次插
入成功。操作過程中血流動力學(xué)改變較輕。結(jié)論 Ctrach喉罩置入簡單、圖象清晰、直視下氣管插
管成功率高，是解決面頸瘢痕攣縮導(dǎo)致的困難氣管插管的有效方法之一。
關(guān)鍵詞：喉面罩；困難氣道；插管法,氣管內(nèi)
中圖分類號：R614 文獻標識碼：A 文章編號：
Use of the fibreoptic intubating LMA CTrachTM
in faciocervical scar contracture patients
YANG Dong, DENG Xiao-ming, TONG Shi-yi, LIU Ju-hui, SUI Jing-hu, ZHANG Yan-ming, LIU Jian-hua,WEI Ling-xin, XU Kun-lin
Department of Anesthesiology，Plastic Surgery Hospital，CAMS and PUMC，Beijing 100144，China
Corresponding author: DENG Xiao-ming Tel: 010-88703937, E-mail: dengxiaoming2003@sina.com
ABSTRACT: Objective To evaluate the feasibility of the fibreoptic intubating LMA CTrachTM
(CTrach) in anticipated difficult airway caused by faciocervical scar contracture. Methods 33 patients,undergoing selective faciocervical scar plastic surgery and requiring general anesthesia. After anesthesia
induction, the CTrach was inserted, the viewer was attached, which allows fibreoptic visualization of the
larynx before and during passage of the tracheal tube through the vocal cords. The time and the success
rates of CTrach insertion, tracheal intubation and CTrach removal were recorded. The view of glottis on
viewer and adjusting manoeuvres for improving the laryngeal view were recorded. Noninvasive blood
pressure and heart rate were recorded before and after anesthesia induction, at CTrach insertion, at
intubation, at CTrach removal. Results The CTrach was inserted successfully in all patients. Among of
these, 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, and
partial view or no view of glottis were shown in 8 and 15 patients, respectively， the good view of glottis
was able to achieved by adjusting manoeuvres, Tracheal intubation via the CTrach was successful in 27
patients at the first attempt, in 6 patients at the second attempt. Hemodynamic changes during the
performance with the CTrach were minimal. Conclusions The CTrach can be inserted easily, the view
is clear, and there is a high success rate of tracheal intubation with the CTrach. It is one of effective means
to solve difficult intubation caused by faciocervical scar contracture.
Key words: Laryngeal mask airway; Difficult airway; Intubation, endotracheal
2008 年中華醫(yī)學(xué)會全國麻醉學(xué)術(shù)年會
2
CTrach 光導(dǎo)纖維可視性氣管插管型喉罩 (CTrach 喉罩) 是在Fastrach 氣管插管型喉罩 (Fastrach
喉罩)的基礎(chǔ)上，在喉罩內(nèi)增加了內(nèi)置性光導(dǎo)纖維束，其近端通過磁性接頭與顯示器相連，遠端開
口于會厭提升板的下方。將 CTrach 喉罩置入口內(nèi)后，連接顯示器，可以在直視下尋找聲門及直視
下完成氣管插管。研究表明，在正常氣道患者，經(jīng) CTrach喉罩引導(dǎo)氣管插管的成功率在 96%以上
[1、2]
，但在面頸瘢痕攣縮導(dǎo)致的困難氣管插管患者的應(yīng)用尚無報道。本研究探討 CTrach 喉罩在面頸
瘢痕攣縮導(dǎo)致的預(yù)測困難氣管插管患者應(yīng)用的可行性。
對象和方法
對象 共 33例 ASAⅠ級，擇期全麻下行面頸瘢痕整形手術(shù)的患者，至少具有一項符合困難氣
道標準(甲頦距離<6cm；張口度<3cm；Mallampati 分級Ⅲ級以上) 。牙齒松動、有胃食道反流危
險的患者排除本研究。
準備 根據(jù)患者的體重選擇合適型號的 CTrach 喉罩，3 號、4 號和5號 CTrach 喉罩分別適用于
30～50kg、50～70kg 和 70kg 以上的患者 ......
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