慢诱导经鼻盲探插管配合EtCO_2波形图在颈椎骨折病人全麻插管中的应用  

Slow induction of blind nasotracheal intubation with EtCO_2 oscillogram in anesthetic intubation of patients with cervical spine fractures

作　　者：张帮健[1] 何林[1] 赵新艳[1] 杨昶[1] 

机构地区：[1]攀枝花市中心医院麻醉科,四川攀枝花617067

出　　处：《现代预防医学》2013年第10期1973-1975,共3页Modern Preventive Medicine

基　　金：攀枝花市2011年度市级应用技术研究与开发资金项目(2011CY-S-7)

摘　　要：目的探讨慢诱导经鼻盲探插管配合EtCO2(呼气末二氧化碳)波形图监测应用于解决颈椎骨折病人困难插管的可行性。方法选ASAⅠ～Ⅲ级择期行手术的颈椎骨折患者50例随机分为两组:A组25例,采用镇静健忘慢诱导经鼻盲探气管内插管;B组25例,采用镇静健忘慢诱导经鼻盲探配合EtCO2波形图气管内插管。观察记录插管次数、插管时间(从开始插管到听诊证实成功)、各个时段的平均动脉压(MAP)、心率(HR)和术后插管并发症。结果 B组患者在T4时刻点的插管血管反应低于A组(P﹤0.05);插管次数B组1～2次的成功率92%,高于A组的60%(P﹤0.05);插管时间B组为(3.25±1.47)min,少于A组的(5.73±2.42)min(P﹤0.05);B组有2例发生声嘶或咽部不适(8%)低于A组有8例发生声嘶或咽部不适(32%)(P﹤0.05)。结论慢诱导经鼻盲探插管配合EtCO2波形图监测用于颈椎骨折患者是一种安全、有效、并发症少的气管插管方法。OBJECTIVE To investigate the feasibility of solving incubation difficulty in patients with cervical spine fractures with slow induction of blind nasotracheal intubation with EtCO2 （end-tidal carbon dioxide） oscillogram monitoring. METHODS Fifty ASA Ⅰ -Ⅲ patients with cervical spine fractures were randomly divided into two groups. A group （n = 25） received slow induction of blind nasotracheal intubation. B group （n = 25） received slow induction of blind nasotracheal intubation with EtCO2 oscillogram. The number of intubation, intubation duration （from the beginning to successful intubation proved by ausculta- tion）, mean arterial pressure （MAP）, heart rate （HR） and complications of the intubation were recorded. RESULTS The changes of MAP and of HR at T4 were obivously smaller in group B than in group A （P 〈 0.05）. The successful rate of incuba- tion for 1 to 2 times was evidently higher in group B than in group A （P 〈 0.05）. The time of intubation was shorter in group B than in group A （P 〈 0.05）. The incidence of complications of the intubation was significantly lower in group B than in group A （P 〈 0.05）. CONCLUSION Slow induction of blind nasotracheal intubation with EtCO2 oscillogram monitoring for patients with cervical fractures is a simple, safe, and effective mean of endotracheal intubation.

关 键 词：慢诱导 气管插管 EtCO2波形图 颈椎骨折 

分 类 号：R614[医药卫生—麻醉学]