PierreRobin序列征患儿行下颌骨牵引成骨术困难气道处理一例

2020-08-14 王建设,刘娇,赵龙德 临床麻醉学杂志

患儿,女,2岁4个月,10kg,因“发现腭部裂开2年余”入院。既往出生后因下颌后缩,上腭部裂开伴呼吸困难,喝奶呛咳,诊断为“Pierre Robin序列征(Pier

患儿,女,2岁4个月,10kg,因“发现腭部裂开2年余”入院。既往出生后因下颌后缩,上腭部裂开伴呼吸困难,喝奶呛咳,诊断为“Pierre Robin序列征(Pierre Robin sequence,PRS),腭裂”,于出生后3个月行“双侧下颌延长器植入术(又称下颌骨牵引成骨术)”。患儿术后恢复一般,6个月时行“双侧下颌延长器取出术”。患儿生长发育较同龄儿童落后。

入院诊断:腭裂,PRS术后。拟于全身麻醉下行腭裂修补术。术前1d访视时患儿外出玩耍未见,家长诉患儿睡觉喜欢侧卧位,有轻微鼾声,饮食一般,胸部X线片未见明显异常,实验室检查未见明显异常。次日患儿进入手术室时发现双侧下颌仍然后缩明显,下颌陈旧性疤痕,张口度小,仅有1.5 cm左右,龋齿,有部分牙齿脱落,右下颌中切牙有松动,发音不清。

患儿入室后静脉注射舒芬太尼2μg和丙泊酚30mg,面罩通气胸廓起伏良好,经口置入可视喉镜2次均失败。加深麻醉,吸入七氟醚并静脉注射琥珀胆碱15mg,可视喉镜勉强进入口腔,调整喉镜位置但会厌仍无法显示,行经喉罩可视插管软镜引导下气管插管。待患儿自主呼吸恢复良好后,复合丙泊酚和七氟醚加深麻醉,先插入排空罩内气体2.0#单管喉罩,辅助通气良好,经喉罩插入2.8mm可视插管软镜,声门清晰可见。退出可视插管软镜,将经过润滑的4.5#无囊导管套在可视插管软镜上插入喉罩内,并在软镜引导下将导管送入主气管内,辅助通气胸廓起伏良好,双肺听诊呼吸音对称,呼气末二氧化碳波形良好,此过程中患儿HR110~145次/分,BP92~103/48~56mmHg,SpO2 90%~100%。后逐渐分3次剪断喉罩并分次取出,调整导管深度,再次听诊两肺通气良好后妥善固定导管。

术中丙泊酚和瑞芬太尼微泵维持麻醉,手术时长1h,术中生命体征平稳,PETCO242~48mmHg,未输血,术毕行动脉血气分析示pH7.307,PCO2 47.6mmHg,PO2 188.8mmHg,BE-3.1mmol/L,Hb104g/L,Na+137.5mmol/L,K+3.78mmol/L,Ca2+1.22mmol/L,Cl-106mmol/L,AnGap11.9mmol/L。术后带管送ICU,术后48h拔管,拔管后次日出ICU,随访未见异常,5d后康复出院。

讨论

PRS主要表现为下颌骨发育不全后缩、舌后坠及气道梗阻等,58%~90%的患儿伴有腭裂或高腭弓,同时可合并有心脏、眼睛及耳朵异常。轻症PRS患儿无临床表现,重者可在出生后就出现不同程度的呼吸及喂养困难、智力障碍、反复发作的肺部感染、窒息等,如不及时治疗可致新生儿期死亡。PRS相应治疗方法也有多种,包括采用辅助进食工具,保持前倾或俯卧体位,放置口咽或鼻咽通气道,唇舌粘连术,气管切开术以及下颌骨牵引成骨术等。

下颌骨牵引成骨术是在截断下颌骨的情况下,应用一定的器械加速下颌骨的成长,在改善呼吸困难、喂养困难的情况下,同时改善了小下颌畸形。但是该方法应用于新生儿也存在一定的损伤和潜在的危险,常见并发症包括:切口感染、面部蜂窝组织炎、感觉异常、外固定装置引起的面部瘢痕等;相对罕见的并发症包括:颞下颌关节僵硬、青枝骨折、骨髓炎、牙胚受损、过早愈合、畸形愈合、固定装置移动、装置故障、面神经麻痹、颊部脓肿、咬合紊乱等。

本例患儿经过前期两次手术后,呼吸及营养情况较前有所改善,但下颌畸形矫正恢复欠佳,第2次取内固定手术麻醉时,气道处理仍有一定难度,考虑与颞下颌关节炎有关。此次张口度小考虑与颞下颌关节僵硬有关。手术前仅有的胸部X线片检查未提示阳性征象,未见有针对气道特殊情况的其他相关影像学检查,术前访视未见到患儿,不清楚气道情况,这些都给腭裂修补手术麻醉的气道管理带来极大的挑战。

患儿有牙齿松动,张口度小,虽无面罩通气困难,在尝试可视喉镜下气管插管失败后,考虑到可视插管软镜较细,口腔存在分泌物,清晰度差,影响插管成功率,遂改用经喉罩可视插管软镜引导下气管插管。成功插入抽空罩体内气体的2号喉罩,通气良好,经罩体插入润滑的软镜,会厌和声门清晰可见,受限于喉罩、软镜型号和患儿发育影响,仅能放入经过润滑的4.5#无囊气管导管,术中虽然存在一定的漏气,但PETCO2在可接受范围内,血气分析结果也支持这一点。因没有专用退出喉罩装置,决定分段剪断喉罩并分次取出,此过程中注意导管深度和位置,防止滑脱。术后患儿在完全清醒状态下拔除导管,未见有异常。

有研究表明,对PRS患儿施行腭裂修复术后出现气道阻塞的危险性明显高于单纯腭裂,主要原因在于PRS疾病本身气道梗阻发生率高,并强调围术期监测重要性。低龄PRS患儿实施腭裂修复术围术期的风险主要是严重的低氧血症。但就PRS患儿行手术纠正下颌畸形后腭裂手术麻醉手术风险的报道很少。在本例中麻醉科医师主观上认为PRS行下颌骨牵引成骨手术治疗后,下颌畸形会纠正,气道症状会明显好转,也未对既往病史进行查阅,加之患儿年龄相对较大,风险降低,因此忽视了气道情况的全面评估,而且手术科室也未对患儿进行气道方面的影像学检查,给患儿安全带来极大的隐患。因此,PRS患儿在进行手术时,术前要完善头颈部影像学检查,对气道情况作出准确评估,并按照困难气道处理流程准备相关器械和药物。因此,今后应进一步完善PRS患儿术前评估以及更加合理、个体化麻醉方案的制定。

原始出处:

王建设,刘娇,赵龙德,费建.Pierre Robin序列征患儿行下颌骨牵引成骨术困难气道处理一例[J].临床麻醉学杂志,2019,35(09):933-934.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (7)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2021-07-14 surilei
  2. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2021-01-05 xlysu
  3. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-26 14818eb4m67暂无昵称

    👍

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-16 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-16 珙桐
  7. [GetPortalCommentsPageByObjectIdResponse(id=1703600, encodeId=c2e01e0360025, content=<a href='/topic/show?id=0d2869594b' target=_blank style='color:#2F92EE;'>#ERR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6959, encryptionId=0d2869594b, topicName=ERR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72d30527892, createdName=surilei, createdTime=Wed Jul 14 21:01:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699830, encodeId=aa99169983093, content=<a href='/topic/show?id=dd152024130' target=_blank style='color:#2F92EE;'>#下颌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20241, encryptionId=dd152024130, topicName=下颌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4f29973299, createdName=xlysu, createdTime=Tue Jan 05 08:01:51 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813301, encodeId=4c3681330172, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Wed Aug 26 08:25:09 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1352246, encodeId=d502135224671, content=<a href='/topic/show?id=e95954093cd' target=_blank style='color:#2F92EE;'>#成骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54093, encryptionId=e95954093cd, topicName=成骨)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1395267, encodeId=b663139526ebb, content=<a href='/topic/show?id=14b3406149a' target=_blank style='color:#2F92EE;'>#困难气道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40614, encryptionId=14b3406149a, topicName=困难气道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419664, encodeId=1b311419664b8, content=<a href='/topic/show?id=e2dc2025888' target=_blank style='color:#2F92EE;'>#下颌骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20258, encryptionId=e2dc2025888, topicName=下颌骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9f63514434, createdName=珙桐, createdTime=Sun Aug 16 06:01:51 CST 2020, time=2020-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809057, encodeId=64ce80905e02, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200814/81d08245657a4a7f9a1ef713c0ec5878/ec4b201a22194a319b1aeb171bc6bb3d.jpg, createdBy=41e02111625, createdName=1581f8c42cm, createdTime=Sat Aug 15 06:17:47 CST 2020, time=2020-08-15, status=1, ipAttribution=)]
    2020-08-15 1581f8c42cm

    0

相关资讯

小儿口底颅脑贯通伤继发性困难气道麻醉管理1例

女,1岁5个月,体重10kg,跌倒时木筷戳入上腭3.5h急诊入院。无呕吐、发热,诉少量出血,既往史无特殊。入院体格检查:神志清楚,脉搏127次/min,呼吸频率30次/min,BP检测不配合,余未见异常。头颅CT示:口腔至右侧后颅窝条索状异物影,长约93mm,直径约4mm,途经右咽旁及破裂孔颈静脉球旁,深入右侧小脑半球约18mm,远端可见小脑斑片出血影;腺样体大,鼻甲大。胸部X线、ECG及实验室检

未预料的困难气道并支气管痉挛致苏醒延迟1例

困难气道的管理与麻醉安全和质量密切相关,30%以上的严重麻醉相关并发症(脑损伤、呼吸心博骤停、不必要的气管切开以及气道损伤等)是由气道管理不善引起的。目前,我国各级医院麻醉医生在气道管理中还存在资源获取不均衡、设备配备不足以及气道处理相关技术普及率不高,危机管理意识不强等问题。尤其基层的麻醉医生,由于多因素条件限制,能够得到的困难气道工具不充足,仪器设备及监测条件限制等,困难气道的管理更是一项巨大

2019 专家意见:麻醉实践中所有年龄段儿童意外困难气道的管理

儿童是一个特殊的群体,在解剖和生理学上均与成人有差异。本文主要针对各个年龄段儿童在麻醉过程中意外困难气道的管理提供指导。