Bissinger U, Plinkert P K, Guggenberger H
Abteilung Anästhesiologie, Klinik für Anästhesiologie und Transfusionsmedizin, Universität Tübingen.
HNO. 1998 Jul;46(7):666-71. doi: 10.1007/s001060050292.
Retrograde or fiberoptic intubation techniques are recommended for patients in whom intubation is difficult; however, each method has its own limitations. Good results have been reported with a combination of both techniques, i.e. retrograde passage of a guidewire through the cricothyroid membrane to guide a fiberoptic bronchoscope. The practicality, success and complication rates of our retrograde-guided fiberoptic bronchoscopic technique (RGFT) were studied prospectively in 93 patients with obstructing tumors scheduled for laryngectomy. The techniques showed itself to be successful, practical and safe, with negligible complications in 89/93 patients (96%). The ability to insert the bronchoscope by means of a guidewire and to direct the intubation procedure optically was found to be advantageous. Limitations with extreme obesity and in two other patients with advanced obstructive carcinomas of the larynx. Additionally, use of the tracheal puncture allows the RGFT to be integrated into clinical medical education as a preparatory exercise for emergency coniotomy.
对于插管困难的患者，推荐采用逆行或纤维光学插管技术；然而，每种方法都有其自身的局限性。有报道称，将两种技术结合使用可取得良好效果，即通过逆行方式将导丝穿过环甲膜，以引导纤维支气管镜。我们对93例计划行喉切除术的阻塞性肿瘤患者进行了前瞻性研究，探讨了逆行引导纤维支气管镜技术（RGFT）的实用性、成功率和并发症发生率。该技术显示出成功、实用且安全，93例患者中有89例（96%）并发症可忽略不计。通过导丝插入支气管镜并通过光学方式引导插管过程的能力被认为具有优势。在极度肥胖患者以及另外两名晚期喉阻塞性癌患者中存在局限性。此外，气管穿刺的使用使RGFT能够作为紧急环甲膜切开术的预演纳入临床医学教育。
