1、Respiratory Support for Tracheal Surgery,prof. Vyzhigina M.A., Titov V.A., prof. Parshin V.D., prof. Rusakov M.A., Aleksander AlekseevSechenov First Moscow State Medical University, Moscow, Russia,High Frequency Jet Ventilation 高频喷射通气Bypass-Breathing with periods of Apnea 旁路通气ECMO 体外膜肺Apneic Oxygena
2、tion 无通气氧合,Respiratory Techniques,1944 - Draper Diffusion respiration 弥散呼吸1956 Holmdahl Diffusion oxygenation 弥散氧合1956 Nahas Apneic oxygenation 无通气氧合,Background,min,Physiology,Draper W. B., Whitehead R. W. & Spencer, J. N. (1947). Studies on diffusion respirations. III. Alveolar gases and venous blo
3、od pH of dogs during diffusion respiration. Anesthesiology, 8, 524-533.,Hemoglobin Oxygen Pump,Continuous Insufflation of humidified O2 into distal part of trachea via catheter ( 14 Fr. ) FiO2=1, 12 L/min通过导管给气管远端持 续供应湿化的氧气Duration of AO from 10 to 40 min (2512.9 min) according to surgical need 根据手术
4、需要实行无通气氧合,Apneic oxygenation,Apneic oxygenation,warming,humidification,22.02.2014 Patient S. 25 y.o. Circular resection of trachea,Endotracheal tube,Catheter,25 patients (from 18 to 58 y.o.) with tracheal stenosis 25例（18岁到58岁）气管狭窄患者Tracheal reconstructive surgeries气管重建术: Circular resection of trache
5、a 气管环切术Tracheoplasty 气管成型术Tracheoesophageal fistula and double level cicatricial tracheal stenosis repair 气管食管瘘与气管瘢痕性狭窄修补术,Patients and Surgeries,Phase of operation before opening lumen of trachea 暴露气管内腔之前- Conventional Ventilation (CV) FiO2=0,5 常规通气模式- Hyperoxygenation (5 min before the main phase
6、FiO2=1) 高浓度氧合（主要步骤前5分钟）Main phase of resection and anastomosis 气管切除与缝合- Apneic oxygenation 无通气氧合After anastomosis 气管吻合后- Conventional Ventilation FiO2=0,5 常规通气模式,Modes,Invasive 有创监测Radial artery catheterization: Blood pressure and heart rate 桡动脉穿刺置管：血压与心率Gases of arterial blood - PaO2, PaCO2动脉血气分析：氧
7、分压与二氧化碳分压Acid-base balance of arterial blood - pH, BE 动脉血酸碱平衡分析- Noninvasive 无创监测SpO2, ETCO2 血氧饱和度，呼气末二氧化碳ECG 心电图,Monitoring,Results,Results (M),Speed of PaCO2 increasing during AO was 2.5 0.5 mmHg per min (min 1.46, max 3.1)无通气氧合模式：动脉血二氧化碳分压上升速度2.5 0.5 mmHg/分钟Speed of PaCO2 increasing during apnea
8、is 4 5 mmHg per min (Vyzhigina M.A. et all, 2010)窒息模式：动脉血二氧化碳分压上升速度4 5mmHg/分钟,Results,Results (M),Conclusions,AO in tracheal surgery is accompanied with a progressively increasing of hypercapnic acidosis and provides a high level of blood oxygenation无通气氧合模式在气管手术中的应用可导致高碳酸性酸中毒和血中氧浓度过高The rate of CO2
9、accumulation during AO in two less than when using the bypass-breathing二氧化碳蓄积速度比旁路通气模式每分钟慢2mmHgAcidosis due to AO does not cause hemodynamic disturbances无通气氧合引起的酸中毒不会影响血流动力学Parameters of PaO2, PaCO2 and pH completely reversible in 20 min after reconnection to the CV恢复常规通气模式20分钟后氧分压，二氧化碳分压，和PH值将恢复正常,
10、AO can be used as a respiratory technique for reconstructive tracheal surgery无通气氧合模式可作为一种通气技术应用于气管重建术The choice of respiratory support is determined by the level and type of injury of trachea, the degree of stenosis, characteristics of the surgical approach and individual of a surgeon通气模式的选择与以下因素有关，
11、气管损伤的类型和位置，狭窄程度，手术医生的个人习惯Proper communication between the anesthesiologist and the surgeon ensures patient safety and improves the results of surgical treatment麻醉医生与手术医生之间良好的沟通可以确保患者安全并提高术后治愈率,Conclusions,tactics of anaesthesia management during transesophageal balloon dilatation of tracheal stenosi
12、s,经食道球囊扩张气管狭窄部位的麻醉策略transesophageal tracheal intubation经食道气管内插管and respiratory techniques during the separation of tracheoesophageal fistula and tracheal resection气管食管瘘气管切除术中的隔离通气技术,Case report,Diagnosis: Tracheoesophageal fistula and double level tracheal stenosis诊断：气管食管瘘合并两个气管环水平的气道狭窄After 38 days
13、 of conventional mechanical ventilation in the ICU due to acute violation of cerebral circulation脑循环障碍后在重症监护室经过38天常规机械通气治疗后形成气管食管瘘,Patient ., 45 y.o. ASA III,3D-CT,Balloon dilatation with Inspira Air,One-Lung Apneic Oxygenation,Alekseev A.V., Vyzhigina M.A., Parshin V.D., Fedorov D.S. Apneic oxygena
14、tion. Anesteziol Reanimatol. 2013 Sept-Oct;(5):69-74. (Review in Russian)Titov V.A., Parshin V.D., Rusakov M.A., Alekseev A.V., Kozhevnikov V.A. Case report of transesophageal tracheal intubation in patient with tracheoesophageal fistula and cicatricial tracheal stenosis. Anesteziol Reanimatol. 2014
15、 (4):74-77. (in Russian)Jimnez, M.J. Sadurn, M. Ti, M. Rovira, I. Fita, G. Martnez, E. Gimferrer, J.M. Gomar, C. Macchiarini, P. Apnoeic oxygenation in complex tracheal surgery: O-58. Eur J Anaesthesiol. 2006 May; Vol. 23 suppl. 38: p. 20.Kolettas AA, Tsaousi GG, Grosomanidis V, Karakoulas KA, Thomareis O, Kotzampassi K, Vasilakos DG. Influence of apneic oxygenation on cardiorespiratory system homeostasis. J Anesth. 2013 Sep 24.,References,http:/www.medlit.ru/en/journal/197/http:/elibrary.ru/contents.asp?issueid=1287945,
