超声在气道管理中的应用

上海交通大学附属第六人民医院麻醉科赵达强

超声在气道管理中的应用2016-5-27颈部气道解剖定位喉上神经Thethyrohyoidmembraneasatargetforultrasonography-guidedblockoftheinternalbranchofthesuperiorlaryngealnerveStopar-PintaricT,VlassakovK,AzmanJ.JClinAnesth.2015Nov;27(7):548-52.Inconclusion,weareproposingananatomicalconceptforanew,simpler,consistentlyreproducible

US-guidediSLNblocktechniqueusingthethyrohyoidmembraneto

definethetargetplaneforlow-volumelocalanestheticinjection.外侧舌骨外侧舌骨超声影像——舌骨、喉上神经外侧过拱桥，甲舌膜里寻喉上定位环甲膜Theconventionalmethod,inspectionandpalpation,hasalowsuccessrate,especiallyinwomen(24–35%).ElliottDS,BakerPA,ScottMR,etal.Accuracyofsurfacelandmarkidentificationforcannulacricothyroidotomy.Anaesthesia2010;65:889–94

LambA,ZhangJ,HungO,etal.AccuracyofidentifyingthecricothyroidmembranebyanesthesiatraineesandstaffinaCanadianinstitution.CanJAnaesth2015;62:495–503BarbeN,MartinP,PascalJ,etal.AnnFrAnesthReanim.2014Mar;33(3):163-6.定位环甲膜Locatingthecricothyroidmembraneinlearningphase:Valueofultrasonography?TheCTMwasaccuratelyidentifiedbypalpationandultrasoundby46%and100%ofresidentsrespectively(P<0.05).KristensenMS,TeohWH,RudolphSS,etal.BrJAnaesth.2015Jun;114(6):1003-4.

定位环甲膜Structuredapproachtoultrasound-guidedidentificationofthecricothyroidmembrane:arandomizedcomparisonwiththepalpationmethodinthemorbidlyobeseWhenusingtheconventionaldigitalpalpationmethod,13of35anaesthetists(37%)wereabletolocatethecricothyroidmembranesuccessfullywithin2min,whereasthesuccessratewas29of35(83%)whenthestructuredstepwiseultrasonographymethodwasapplied(P=0.0008,McNemar’stest).SiddiquiN,ArzolaC,FriedmanZ,etal.Anesthesiology.2015Nov;123(5):1033-41.

定位环甲膜UltrasoundImprovesCricothyrotomySuccessinCadaverswithPoorlyDefinedNeckAnatomyUltrasoundguidancesignificantlydecreasedtheincidenceofinjuriestothelarynxandtracheaIncreasedtheprobabilityofcorrectinsertionby5.6times

incadaverswithdifficultandimpossiblelandmarkpalpation.外侧甲状软骨声带声带环甲膜外侧超声影像——甲状软骨、环甲膜外侧越尖峰，缺口伪影环甲膜甲状软骨声带声带伪影超声影像环状软骨外侧气管软骨甲状腺峡部外侧气管软骨外侧Ultrasound-guidedsuperiorlaryngealnerveblockandtranslaryngealblockforawaketrachealintubationinapatientwithlaryngealabscessIidaT,SuzukiA,KunisawaT,etal.JAnesth(2013)27:309–310临床应用1—清醒插管SonographicallyGuidedSuperiorLaryngealNerveBlockDuringAwakeFiberopticIntubationSawkaA,TangR,VaghadiaH.AACaseRep.2015Apr15;4(8):107-10.Sonographicallyguidedsuperiorlaryngealnerveblockmaybeusefulinpatientswhereidentificationoflandmarksintheneckisdifficult

asaresultofpatientanatomy临床应用1—清醒插管临床应用1—清醒插管Ultrasound-guided

CannulaCricothyroidotomySuzukiA,IidaT,kunisawaT,etal.Anesthesiology2012Nov;117(5):1128Ultrasound-assistedtranslaryngealblockforawakefibreopticintubationDeOliveiraGSJr,FitzgeraldP,KendallM.CanJAnesth.201158:664–665临床应用1—清醒插管病态肥胖BMI60临床应用1—清醒插管临床应用1—清醒插管临床应用2—判断喉镜显露困难气管软骨外侧食管甲状腺WuJ,DongJ,

DingY,

etal.MedSciMonit,2014;20:2343-2350RoleofanteriornecksofttissuequantificationsbyultrasoundinpredictingdifficultlaryngoscopyAnteriornecksofttissuethicknessesmeasuredbyUSathyoidbone,thyrohyoidmembrane,andanteriorcommissurelevelsareindependentpredictorsofdifficultlaryngoscopy.CombinationsofthosescreeningtestsorriskfactorswithUSmeasurementsmightincreasetheabilitytopredictdifficultlaryngoscopy.临床应用2—判断喉镜显露困难气管软骨外侧食管甲状腺Ultrasonographicmeasurementoftheminimaltransversediameterofthesubglotticairwayinthetransverseplane,typicallyatthecaudaloutletofthecricoidring临床应用3—选择适合气管导管临床应用4—判断气管导管位置气管软骨外侧食管甲状腺排除食管内插管证实气管导管在气管内临床应用4—判断气管导管位置THESENSITIVITYANDSPECIFICITYOFTRANSCRICOTHYROIDULTRASONOGRAPHYTOCONFIRMENDOTRACHEALTUBEPLACEMENTINACADAVERMODELDynamicassessmentresultedin97%sensitivityand100%specificityfordetectingesophagealETplacement.Staticassessmentresultedinonly51%sensitivityand91%specificity.MaG,DavisDP,SchmittJ,etal.JEmergMed.2007May;32(4):405-7.

气管插管过程中环甲膜改变气管导管气囊充气表现临床应用5—判断喉罩位置Laryngo-trachealultrasonographytoconfirmcorrectendotrachealtubeand

laryngealmaskairwayplacementSonographicupperairwayassessmentemergesasa

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