作　　者： ; ; ; ;

机构地区： 广州医科大学

出　　处： 《中华麻醉学杂志》 2019年第2期231-234,共4页

摘　　要： 目的采用CT三维重建技术分析喉镜显露困难的Pierre Robin序列征患儿上气道解剖结构的变化特点。方法择期全麻下行下颌骨牵引成骨术的Pierre Robin序列征患儿50例,性别不限,年龄10~101 d,体重2.0~6.3 kg,ASA分级Ⅲ级。术前在患儿自然睡眠时采用口腔颌面锥形束CT进行扫描,获取上气道解剖学信息,图像导入三维图像处理软件MIMICS 17.0,重建口腔颌面诸骨及气道三维图像。测量相关解剖学参数,包括上中切牙牙槽嵴至会厌根部距离(D1);会厌根部至声门中点距离(D2);下颌骨下缘至声门中点距离(D3);下中切牙牙槽嵴至下颌骨下缘距离(D4);下颌骨升支部长度(D5)、下颌骨体部长度(D6)、下颌骨升支部长度与下颌骨体部长度的总和即总下颌骨长度(D7);上中切牙牙槽嵴、会厌根部、声门中点三者以会厌根部为交点和以上中切牙牙槽嵴为交点所成角的度数(角1、2);下中切牙牙槽嵴、下颌骨下缘、声门中点三者以下颌骨下缘为交点所成角的度数(角3);上中切牙牙槽嵴、硬腭后缘和会厌根部三者以硬腭后缘为交点所成角的度数(角4);两侧下颌角的度数(角5);下颌角两侧的下颌角点与颏部的颏顶点以颏顶点为交点所成角的度数(角6);会厌尖端气道截面积、口腔容积、腭咽腔容积和舌咽腔容积。在利多卡因表面麻醉下行纤维支气管镜引导气管插管,成功后静脉注射丙泊酚、舒芬太尼和顺式阿曲库铵麻醉诱导,然后送入手术室。吸入七氟醚维持麻醉。采用喉镜观察声门显露程度,根据患儿是否为喉镜显露困难(Cormack-Lehane分级Ⅲ级或Ⅳ级)分为喉镜显露困难组(A组)和非喉镜显露困难组(B组)。结果与B组相比,A组会厌尖端气道截面积和腭咽腔容积减小(P<0.05),D1、D2、D3、D4、D5、D6、D7、角1、角2、角3、角4、角5、角6、口腔容积和舌咽腔容积差异无统计学意义(P>0.05)。结论喉镜显露困难的Pierre Robin� Objective To analyze the anatomical characteristics of the upper airway in Pierre Robin sequence pediatric patients with difficult laryngoscopy using the computed tomography-based three-dimensional reconstruction.Methods Fifty pediatric patients of both sexes with Pierre Robin sequence,aged 10-101 days,weighing 2.0-6.3 kg,of American Society of Anesthesiologists physical statusⅢ,scheduled for elective mandibular distraction osteogenesis under general anesthesia,were enrolled in this study.Cone beam CT scan was performed to obtain upper airway anatomy information during the natural sleep before operation.Images were imported into medical engineering software MIMICS 17.0 to reconstruct the three-dimensional images of the oral and maxillofacial bones and airways.The related anatomical parameters were measured,including the distance between the alveolar ridge of the upper central incisor and root of the epiglottis(D1),distance between the root of the epiglottis and midpoint of glottis(D2),distance between the bilateral lower edge of the mandible and midpoint of glottis(D3),distance between the alveolar ridge of the lower central incisor and the lower edge of the mandible(D4),length of the mandibular ramus(D5),length of the mandible body(D6),and length of the total mandible(D7),angle between lines D1 and D2(angle 1),the angle between line D2 and the alveolar ridge of the upper central incisor to the midpoint of glottis(angle 2),the angle between lines D3 and D4(angle 3),the angle of the point of the upper central incisor alveolar ridge to the trailing edge of the hard palate and then to the root of epiglottis(angle 4),the angle of bilateral mandible(angle 5),the angle of the point of gnathion to the two gonions(angle 6),the airway cross-sectional area at the tip of epiglottis,volume of oral cavity,volume of velopharyngeal cavity,and volume of glossopharyngeal cavity.Fiberoptic bronchoscope-guided endotracheal intubation was performed under topical anesthesia with lidocaine.Propofol,sufentanil and cis-atracurium were

关 键 词： 综合征 喉镜检查 成像 三维 解剖学 局部

领　　域： []