国际麻醉学与复苏杂志   2018, Issue (1): 0-0
    
颌面颈部创伤患者的气道管理进展
白晶, 栾永1()
1.大连医科大学附属第一医院
Airway management of maxillofacial and neck trauma patients
 全文:
摘要:

背景 颌面颈部创伤患者救治的关键环节之一是气道管理,其特点是难度大、风险高。两类创伤既有共同特点,又可能相互牵制、相互干扰,给伤后气道管理带来不同程度的困难。 目的 针对两类创伤患者气道管理方法近年来的进展情况进行综述。 内容 阐述颌面颈部创伤患者的气道特点、各种气道管理方式及其优缺点、气道管理注意事项等。 趋向 颌面颈部创伤可能造成病理上的困难气道(如气道解剖形态的改变),或麻醉医师因忌惮严重的继发损伤(如截瘫)而不能很好地暴露声门,造成实际意义上的困难气道。颌面颈部创伤患者经鼻气管插管的应用较经口气管插管更为普遍,在经鼻气管插管存在禁忌或难以实施时,可选择经口气管插管、颏下插管及气管切开。各种插管辅助工具中,纤维支气管镜对颈椎保护意义最大。另外,麻醉医师对插管时机的把握及对辅助工具使用的熟练程度也对该类患者气道管理具有重要意义。

关键词: 颌面颈部创伤; 气道管理
Abstract:

Background Airway injury has been commonly seen after maxillofacial trauma and neck trauma, and this complication increases mortality in patients. Therefore, airway management is crucial to prevent death in patients with maxillofacial and neck trauma. Objective To review the characteristics of maxillofacial trauma and neck trauma, and the management of injured airway in these conditions. Content Different from maxillofacial trauma, neck trauma often causes damage in cervical nerve and spine, which complicates airway management. In patient with maxillofacial trauma, tracheal ventilation can be achieved through a tubing from nose, mouth, submentum, and an incision in trachea. In patients with neck trauma, tracheal ventilation should be under the guidance of laryngoscope or optical fiber to avoid further damages in airway, and appropriate strategies may be required to stabilize the tubing. Trend Mechanical ventilation is an important procedure in airway management in patients suffered from maxillofacial and neck trauma. Strategies and devices to maintain adequate ventilation in patients should be the focuses of the future studies.

Key words: Maxillofacial and neck trauma; Airway management