Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管的临床研究  

A clinical study on tracheal intubation by combination of fiberoptic bronchoscope and Aintree intubation catheter via Proseal laryngeal mask airway in patients with unstable cervical vertebrae

作　　者：赵一凡[1] 胡楚文[1] 王飞[1] 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广东广州510120

出　　处：《岭南现代临床外科》2011年第5期383-385,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的通过与清醒经鼻支纤镜插管对比,研究Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管的有效性和安全性。方法因颈椎骨折或严重颈椎间盘突出拟行颈椎减压内固定手术的患者40例,随机分配至以下两组:A组20例,清醒表麻后行经鼻支纤镜引导插管,然后麻醉诱导;B组20例,常规麻醉诱导后置入Proseal喉罩,沿喉罩在支纤镜引导下将Aintree导管插入气管内,退出喉罩后经Aintree导管置入气管插管。监测插管前(T0)、开始插管(T1)、插管成功时(T2)、插管成功后1min(T3)、插管成功后3min(T4)的平均动脉压(MAP)和心率(HR);记录支纤镜插管时间、插管总时间(表麻时间或置喉罩时间加支纤镜插管时间)和插管相关并发症。结果 A组有1例因不能配合改为诱导后支纤镜插管,B组所有病例插管成功。T2和T3两时点,A组HR(92±17次/分,95±18次/分)显著高于B组(78±13次/分,83±17次/分);T3时点A组MAP(93±28mmHg)显著高于B组(80±24mmHg)(P<0.05);A组在T2、T3两时点的HR、MAP均显著高于各自的T0时点基础值(P<0.05)。插管的总时间两组相当(A组184±55s,B组179±27s,P>0.1),而B组支纤镜插管时间较短(A组62±32s,B组39±18s,P<0.05)。两组患者术后无任何插管相关并发症。结论 Proseal喉罩与支纤镜联合Aintree导管用于颈椎不稳患者气管插管与传统支纤镜清醒插管效果相当,但血流动力学更平稳,是安全有效的困难气道处理新技术。Objective To observe the effect and safety on tracheal intubation by combination of fiberoptic bronchoscope and Aintree intubation catheter via Proseal laryngeal mask airway in patients with unstable cervical vertebrae when comparing with awake post nasal fiberoptic intubation. Methods Forty patients with cervical fracture or severe herniation of cervical disc scheduled for cervical decompression and internal fixation were divided randomly into two groups. Patients in Group A （n= 20） were intubated by awake post nasal fiberoptic techenique after local anesthesia. Patients in Group B （n=20）were ventilated by Proseal laryngeal mask after anesthesia induction,and endotracheally intubated with Aintree intubation catheter by guidence of the fiberoptic bronchoscope. After removal of fiberscope and laryngeal mask,a tracheal tube was inserted along the Aintree intubation catheter （AIC）. The mean artery blood pressure （MAP） and heart rate （HR）were monitored before the intubation （TO）, at the beginning of the intubation （T1）, successfully intubation （T2）, lmin after intubation （T3）, 3 min after intubation （T4）. Time of inserting the fiberscope, the total time of tracheal intubation and the complications related to tracheal intubation were recorded. Results One patient failed to cooperate with the awake nasal fiberoptic intubation and changed into intubation after induction. All patients were intubated successfully in Group B. The HR of patients in Group A （92± 17 bpm, 95±18 bpm） was significantly higher than that in Group B （78±13 bpm,83±17 bpm） at T2 and T3. The MAP of patient, in Group A （93±28 mmHg） was significantly higher than that in GroupB （80±24 mmHg） at T3 （P〈0.05）. The HR and MAP at T2 and T3 were significantly higher than that at T0（P〈0.05）. There was no difference in the total time of intubation between two groups （184±55s of Group A, 179_＋27s of Group B,P〉0.1）, but the time of inserting the fiberscope in Group B was shorter than

关 键 词：PROSEAL喉罩 Aintree导管 困难气道 

分 类 号：R614.2[医药卫生—麻醉学]