“无管”自主通气电视胸腔镜气管手术中的气道管理：一项回顾性观察性病例系列研究,Journal of Cardiothoracic Surgery

当前位置： X-MOL 学术 › J. Cardiothorac Surg. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

“无管”自主通气电视胸腔镜气管手术中的气道管理：一项回顾性观察性病例系列研究
Journal of Cardiothoracic Surgery ( IF 1.6 ) Pub Date : 2023-02-04 , DOI: 10.1186/s13019-023-02157-w
Yuying Liu ₁ , Lixia Liang ₁ , Hanyu Yang ₁

Affiliation

在无内胎自主通气电视胸腔镜手术（SV-VATS）气管切除重建阶段，外科医生和麻醉师以更简单的方式共享气道。无内胎 SV-VATS 对麻醉师来说意味着切除和重建阶段的稳定自主通气，对外科医生来说意味着手术视野畅通无阻。“视野无内胎”SV-VATS气管手术期间理想的气道管理策略是什么仍然是该领域的一个悬而未决的问题。我们回顾性分析了研究期间（2018-2020 年）在我院未行袖状和隆突切除术的 33 例患者。这些患者的初始管理策略是胸腔内气管切除重建的自主通气。我们从我们机构的临床病历系统中获取并审查了病历，以评估无内胎 SV-VATS 气管切除术的气道管理策略和设备故障率。2018 年至 2020 年间，SV-VATS 首次尝试在 33 名接受胸腔内气管手术但未进行袖状和隆突切除的患者中进行。所有患者均接受了支气管镜检查 (33/33)，8 名患者 (8/33) 在术前接受了部分切除术。在手术期间，气道装置包括 ProSeal 喉罩气道 (ProSeal LMA) (n = 27) 或单腔气管导管 (n = 6)。在切除和重建阶段，视野无管 SV-VATS 9 例患者失败，和呼吸支持切换到 B 计划，这是传统的单腔气管插管通气，用于跨场插管 (n = 4) 和 ProSeal LMA 以及高频导管（高频喷射通气，HFJV） (n = 5)远端气管通气。在此队列中未观察到术前呼吸衰竭或其他通气相关并发症。根据当前的分析，ProSeal LMA 或气管插管是无内胎 SV-VATS 的有效气道管理策略，需要适当的患者选择。当通风不足时，它还提供呼吸支持转换选项。在此队列中未观察到术前呼吸衰竭或其他通气相关并发症。根据当前的分析，ProSeal LMA 或气管插管是无内胎 SV-VATS 的有效气道管理策略，需要适当的患者选择。当通风不足时，它还提供呼吸支持转换选项。在此队列中未观察到术前呼吸衰竭或其他通气相关并发症。根据当前的分析，ProSeal LMA 或气管插管是无内胎 SV-VATS 的有效气道管理策略，需要适当的患者选择。当通风不足时，它还提供呼吸支持转换选项。

"点击查看英文标题和摘要"

Airway management in “tubeless” spontaneous-ventilation video-assisted thoracoscopic tracheal surgery: a retrospective observational case series study

Surgeon and anesthetist share the airway in a simpler way in the resection and reconstruction phase of tracheal surgery in tubeless spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS). Tubeless SV-VATS means stable spontaneous ventilation in the resection and reconstruction phase to anesthesiologist, and unobstructed surgical field to surgeon. What’s the ideal airway management strategy during “Visual Field tubeless” SV-VATS for tracheal surgery is still an open question in the field. We retrospectively reviewed 33 patients without sleeve and carina resections during the study period (2018–2020) in our hospital. The initial management strategy for these patients was spontaneous ventilation for intrathoracic tracheal resection and reconstruction. We obtained and reviewed medical records from our institution’s clinical medical records system to evaluate the airway management strategy and device failure rate for tracheal resection in Tubeless SV-VATS. Between 2018 and 2020, SV-VATS was first attempted in the 33 patients who had intrathoracic tracheal surgery but without sleeve and carina resections. All patients underwent bronchoscopy (33/33) and 8 patients (8/33) received partial resection before surgery. During the surgery, the airway device comprised either a ProSeal laryngeal mask airway (ProSeal LMA) (n = 27) or single lumen endotracheal tube (n = 6). During the resection and reconstruction phase, Visual Field tubeless SV-VATS failed in 9 patients, and breathing support switched to plan B which is traditional ventilation of a single lumen endotracheal tube for cross field intubation (n = 4) and ProSeal LMA alongside a high-frequency catheter (high-frequency jet ventilation, HFJV) (n = 5) into the distal trachea ventilation. Preoperative respiratory failure or other ventilation-related complications were not observed in this cohort. Base on current analysis either ProSeal LMA or endotracheal tube is an effective airway management strategy for tubeless SV-VATS with appropriate patient selection. It also provides breathing support conversion option when there’s inadequate ventilation.

更新日期：2023-02-04

点击分享查看原文

点击收藏

公开下载

阅读更多本刊最新论文本刊介绍/投稿指南

全部期刊列表>>