Matsuda Norimasa, Matsumoto Satoshi, Nishimura Taku, Wakamatsu Hiroya, Kunihiro Mitsuru, Sakabe Takefumi
Department of Critical Care Medicine, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan.
J Anesth. 2006;20(2):113-7. doi: 10.1007/s00540-005-0379-0.
Tracheobronchial stenting was performed under general anesthesia, with (six patients) or without (two patients) muscle relaxant, in eight patients suffering from carcinoma. All patients had presented preoperatively with dyspnea, exhibiting Hugh-Jones grade 4 or 5. Three patients had been mechanically ventilated before the procedure. The procedure was performed under general anesthesia with flexible bronchoscopic guidance. Stent placement was performed either through an orotracheal tube (four patients) or through a transtracheal tube (two patients) in those who had no upper tracheal stenosis, while it was performed through a laryngeal mask airway in two patients with upper tracheal stenosis. During the procedure, arterial hemoglobin oxygen saturation (Sp(O(2)) decreased in all patients, despite fraction of inspired oxygen (FI(O(2)) being maintained at 1.0. Except for two patients, one of whom developed superior vena cava syndrome and one, tension pneumothorax after stent placement, there were no complications resulting from stent placement. Six patients were weaned from mechanical ventilation (0-24 days after the procedure). Two of the three patients who had been on mechanical ventilation preoperatively could not be weaned. Stent insertion is an effective treatment for tracheobronchial stenosis, but its indications in patients with malignancy who have been mechanically ventilated prior to stenting should further be evaluated.
对8例癌症患者实施了气管支气管支架置入术，其中6例在全身麻醉下使用了肌肉松弛剂，2例未使用。所有患者术前均有呼吸困难，表现为Hugh-Jones 4级或5级。3例患者在手术前已接受机械通气。该手术在全身麻醉和可弯曲支气管镜引导下进行。对于无上段气管狭窄的患者，通过气管内插管（4例）或经气管插管（2例）放置支架，而对于2例有上段气管狭窄的患者，则通过喉罩气道放置支架。手术过程中，尽管吸入氧分数（FiO₂）维持在1.0，但所有患者的动脉血红蛋白氧饱和度（Sp(O₂)）均下降。除2例患者外，1例出现上腔静脉综合征，1例在支架置入后发生张力性气胸，支架置入未引起其他并发症。6例患者脱机（术后0至24天）。术前接受机械通气的3例患者中有2例无法脱机。支架置入是治疗气管支气管狭窄的有效方法，但对于术前已接受机械通气的恶性肿瘤患者，其支架置入的适应证应进一步评估。
