重度强直性脊柱炎患者纤支镜引导下清醒气管插管一例

游意莹 王艳玲 谢汉镔

【摘要】强直性脊柱炎（AS）是一种以中轴关节受累为主的慢性炎症性疾病，严重者发生脊柱强直和畸形，属于困难气道的高危情况。该类患者术前应充分评估和准备，选择最佳麻醉方案，减少并发症发生。该文报道1例47岁男性腰椎、胸椎、颈椎强直，双髋关节、双膝关节强直呈“S”型固定体位的重度AS患者，因椎管内肿物拟于全身麻醉下接受手术治疗，使用右美托咪定清醒镇静在纤维支气管镜引导下气管插管的成功案例。该例提示右美托咪定清醒镇静不仅对呼吸功能影响轻微，而且能够提高患者接受操作期间的舒适度和配合度，为纤维支气管镜引导下气管插管提供满意的条件。

【关键词】强直性脊柱炎;纤维支气管镜;清醒气管插管;右美托咪定

Awake tracheal intubation guided by fiberoptic bronchoscope in a patient with ankylosing spondylitis： one case report You yiying， Wang Yanling，Xie Hanbin. Department of Anesthesiology， the Third Affiliated Hospital of Sun Yat-sen University， Guangzhou 510630， China

Corresponding author， Wang Yanling

【Abstract】Ankylosing spondylitis （AS） is a chronic inflammatory disease mainly involving the axial joints. Spinal ankylosis and deformity can occur in severe cases， which belong to high risk of difficult airway. Comprehensive preoperative evaluation and preparation and optimal anesthetic plan should be performed to decrease the incidence of complications for these patients. We reported a case of severe AS （47-year-old male） manifested with lumbar， thoracic and cervical vertebral ankylosis complicated with ankylosis of bilateral hip and knee joints in a “S”-shaped fixation posture. The patient was scheduled to undergo surgery under general anesthesia due to the mass in the spinal canal. The patient was sedated with dexmedetomidine and intubated under the guidance of fiberoptic bronchoscope. This case prompts that dexmedetomidine can provide satisfactory intubation conditions for awake intubation under the guidance of fiberoptic bronchoscopy in the patient with severe AS， which not only exerts slight impact on patient’s breathing， but also can achieve a high degree of comfort and cooperation.

【Key words】Ankylosing spondylitis; Fiberoptic bronchoscope; Awake tracheal intubation;

Dexmedetomidine

强直性脊柱炎（AS）是以青年男性为好发人群的一种反复发作的慢性、自身免疫性、进行性的脊椎关节病，主要以脊柱、骶髂关节等中轴关节受累为主，最终可发展为脊柱或关节的强直和畸形，严重者可累及颞下颌关节导致张口度受限，并出现主动脉瓣关闭不全、限制性通气功能障碍等关节外表现，严重影响患者的生活质量，致残率极高[1]。上述因素均增加了患者的麻醉风险，因此我们术前需对此类患者进行充分评估[2]。本文报道1例因AS病史20余年致颈椎和全身多关节强直呈“S”型固定体位的特殊患者，需在全身麻醉下接受椎管内肿物切除手术，麻醉团队充分设计气管插管方案和应急预案，并结合舒适化医疗的理念，使用右美托咪定镇静及咽喉部局麻药充分浸润、环甲膜穿刺局部麻醉药注射等方法在保证患者气道安全的前提下，做到患者发生最轻的气道反射，达到最高的舒适度。……