2008 年中华医学会全国麻醉学术年会

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    ·麻醉相关新技术新业务进展·

    CTrach 光导纤维可视性气管插管型喉罩在面颈瘢痕挛缩患者中的应用

    中国医学科学院 北京协和医学院 整形外科医院麻醉科(北京，100144)

    杨冬，邓晓明，佟世义，刘具会，隋静湖，张雁鸣，刘建华，魏灵欣，胥琨琳

    摘要：目的 评价 CTrach 光导纤维可视性气管插管型喉罩(CTrach 喉罩)在面颈瘢痕挛缩导

    致的预测困难气道处理中应用的可行性。 方法 择期在全麻下行面颈瘢痕整形手术的预测困难气道

    患者 33 例，麻醉诱导后，置入 CTrach喉罩，连接显示器，在直视下寻找声门，进而直视气管插管。

    记录 CTrach喉罩置入、气管插管、CTrach 喉罩退出的次数、时间及成功率，显示器上所见声门的

    情况以及为寻找声门所采用的手法，并记录麻醉诱导前、后，置入 CTrach 喉罩后即刻、插入气管

    导管后即刻及退出 CTrach 喉罩后即刻的血压和心率变化。结果 33 例患者均成功置入 CTrach 喉

    罩，其中 4 例第 2 次成功置入。10 例显示器上直视全部声门，8 例和 15 例分别在显示器上见到部

    分声门或不见声门，调整后获得满意图像。经 CTrach 喉罩27 例首次气管插管成功，6 例第2 次插

    入成功。操作过程中血流动力学改变较轻。结论 Ctrach喉罩置入简单、图象清晰、直视下气管插

    管成功率高，是解决面颈瘢痕挛缩导致的困难气管插管的有效方法之一。

    关键词：喉面罩；困难气道；插管法,气管内

    中图分类号：R614 文献标识码：A 文章编号：

    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 年中华医学会全国麻醉学术年会

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    CTrach 光导纤维可视性气管插管型喉罩 (CTrach 喉罩) 是在Fastrach 气管插管型喉罩 (Fastrach

    喉罩)的基础上，在喉罩内增加了内置性光导纤维束，其近端通过磁性接头与显示器相连，远端开

    口于会厌提升板的下方。将 CTrach 喉罩置入口内后，连接显示器，可以在直视下寻找声门及直视

    下完成气管插管。研究表明，在正常气道患者，经 CTrach喉罩引导气管插管的成功率在 96%以上

    [1、2]

    ，但在面颈瘢痕挛缩导致的困难气管插管患者的应用尚无报道。本研究探讨 CTrach 喉罩在面颈

    瘢痕挛缩导致的预测困难气管插管患者应用的可行性。

    对象和方法

    对象 共 33例 ASAⅠ级，择期全麻下行面颈瘢痕整形手术的患者，至少具有一项符合困难气

    道标准(甲颏距离<6cm；张口度<3cm；Mallampati 分级Ⅲ级以上) 。牙齿松动、有胃食道反流危

    险的患者排除本研究。

    准备 根据患者的体重选择合适型号的 CTrach 喉罩，3 号、4 号和5号 CTrach 喉罩分别适用于

    30～50kg、50～70kg 和 70kg 以上的患者 ......