摘要
唇、腭裂修复术的麻醉要求麻醉医生:熟悉唇、腭裂的手术方式及唇、腭裂患儿的解剖生理特点及异常;了解唇腭裂常见的与麻醉有关的并发症,特别是颅颌面畸形对气管插管的影响;了解气管内插管困难的影响因素;掌握困难气管内插管术前评估的方法,包括病史和体检、特殊筛查试验、放射学检查、喉镜检查等。困难气管内插管手术前评估的方法应联合应用,综合评估。作者总结出一套临床实用又方便的困难气管内插管手术前评估的方法:(1)望(looking or watching)观察头面部发育畸形、小颌畸形、牙牙合关系、脊柱及四肢,有无漏斗胸(可能存在呼吸道不通畅)。(2)闻(hearing or listening)听患者说话的声音和婴儿哭的声音,喉蹼会有声嘶,会厌软骨钙化不全时会有喉鸣音,Robin序列征有口含东西的声音。(3)问(asking)了解有无出生时窒息(小颌畸形、脑瘫、智力障碍多存在),预测拔管后的情况;了解睡眠能否平卧、睡眠姿势、是否打鼾,有无呼吸道梗阻及憋醒;了解有无喂养困难。(4)切(checking)张口度(Mallampati分级)、仰头(颈部屈伸度)、颏甲距离、前伸牙牙合关系、喉镜检查,放射学检查(颈椎畸形),CT、MRI(咽腔、喉头有无异常)。
The anesthesia of infancy patients requires that doctors have a good knowledge of the surgery procedures and anatomic characters, as well as the relationship between eranio-maxillofacial malformation and intubation problems. It is of great importance to evaluate the factors which make intu-hation difficult, such as patient history, physical examination, special radiology examination and laryngoscope examination. The methods of preoperative evaluation of difficult tracheal in-tubation should be used associatedly and synthetically. The author puts forward a series of convenient and practical meth-ods on how to evaluate intubation difficulties preoperatively, the details being as follows. Looking or watching: craniofacial malformation, micromandible, abnormal occlusion and other malformation of vertebra and extremity, and infundibular chest often indicate breath obstascle. Hearing or listening: listen carefully when patients are talking or crying, hoarseness indi-cate laryngeal wed; laryngeal stridor often comes with incom-plete calcified cartilage epiglottiea; patients with Robin syn-drome often sounds like having something in their mouth. Ask-ing: ask the parents wether the baby had suffocation when born, which often comes with micromandible and cerebral pal-sy dysgnosia, and whether there is prostration, snore or airway ohstractian during sleep. Ask whether they have feeding diffi-culty. Checking: check the patient about mallampati, neck mo-bility, distance between mental and thyroid cartilage, and pro-traction occlusion. Use laryngoscope and radiological examina-tion to see whether there is problem with cervical spine, laryn-geal or pharynx.
出处
《中国实用口腔科杂志》
CAS
2009年第6期329-333,共5页
Chinese Journal of Practical Stomatology
关键词
腭裂
困难气管内插管
术前评估
cleft palate
difficult endotracheal intubation
preoperative evaluation
