一例重度强直性脊柱炎行双髋置换的麻醉处理

Narcotic Treatment for Severe Ankylosing Spondylitis with Double Hip Replacement: A Case Report

摘要: 解决非急症气道困难气管内插管问题。方法：麻醉方案有以下四种：方案一，使用插管型喉罩经口腔插入气管导管；方案二，清醒经鼻纤支镜引导下气管插管；方案三，由耳鼻喉科在患者清醒的状态下进行气管切开，经气管切开口插入气管导管；方案四，若以上方案不能成功插管，放弃手术，保证患者生命安全。结果：后经鼻纤支镜引导下气管插管成功。结论：患者的颈，包括上下颌关节严重强直造成张口度小于1.5 cm和口腔解剖结构发生变化，导致插管型喉罩在口腔内不能按正常结构顺利到达指定位置，以致纤支镜下去找不到声门，进而使用经鼻插管。本例患者不存在困难面罩通气，只是困难气管内插管，属于非急症气道。大约90%以上的气管插管困难病人可以通过术前评估被发现。对于已知的困难气道有准备、按照一定规则有步骤地处理将显著增加病人安全性。

Abstract: This report aims to solve endotracheal intubation for the non-acute airway difficulties. Method: Anesthesia program has the following four categories: Option I, using intubation laryngeal mask to insert through the oral endotracheal tube; Option II, sober nasal bronchoscopy guided tracheal intubation; Option III, using tracheotomy insert the endotracheal tube through the trachea cut openings in patients awake state; Option IV, if the above program cannot be successful intubation, then give up surgery to ensure the safety of patients. Results: Intubation guided by nose bronchoscopy was proved to be successful. Conclusion: The patient’s neck joint (including the upper and lower jaws) was severe ankylosis which cause mouth opening less than 1.5 cmand oral anatomical structures has changed, leading to intubation laryngeal mask in the normal structure of the mouth cannot be successfully arrived at the designated location, resulting bronchoscopy down cannot find glottis, then we use nasal intubation. In this report, the patient has non-acute airway difficulties which belong to difficult endotracheal intubationdoes instead of difficult mask ventilation. Difficult tracheal intubation in about 90% of the patient can be found through the preoperative assessment. Prepared for the known difficult airway, systematic processing in accordance with certain rules will significantly increase patient safety.