光棒引导经鼻气管内插管在困难气道患者气管插管中的应用及其效果评价  

Application and effectiveness evaluation of nasotracheal intubation using lightwand in patients with difficult airways during intubation

作　　者：董迎春[1] 邵云[1] 苏荣祥[1] 吴蔚媚[1] 李刚[1] 

机构地区：[1]南京大学医学院附属口腔医院麻醉科,江苏南京210008

出　　处：《吉林大学学报（医学版）》2013年第3期592-596,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81100768);江苏省南京市医学科技发展专项资金资助课题(YKK11040)

摘　　要：目的:探讨光棒引导经鼻气管内插管用于口腔颌面外科困难气道患者气管插管中的有效性,为困难气道的管理提供新方法。方法:ASAⅠ或Ⅱ级困难气道且拟行经鼻气管插管的患者76例,随机均分为光棒引导组(光棒组)和盲探组,每组38例。光棒组借助颈前光点引导进行插管,而盲探组依靠患者的呼吸声引导插管。比较2组患者插管成功率、插管时间、插管期间平均动脉压(MAP)和心率(HR)的变化及术后插管并发症的发生率。结果:光棒组患者插管成功率(89.5%,34/38)高于盲探组(71.1%,27/38)(P<0.05);插管时间[(89.9±26.8)s]短于盲探组[(134.9±32.8)s](P<0.001);光棒组术后咽痛发生率(14.7%,5/34)亦低于盲探组(40.7%,11/27)(P<0.05);声音嘶哑和鼻出血发生率组间比较差异无统计学意义(P>0.05)。插管期间光棒组患者插管中和插管1min MAP值低于盲探组,2组患者各时间点HR差异无统计学意义(P>0.05);结论:光棒引导经鼻气管内插管简单、实用,较经鼻盲探插管成功率高,血流动力学平稳,且不良反应少,是困难气道患者行经鼻气管插管的有效途径之一。Objective To evaluate the effectiveness of nasotracheal intubation using lightwand in patients with difficult airways in oral and maxillofacial surgery,and to provide a new method for difficult airway management.Methods 76 ASAⅠor Ⅱ grade patients with difficult airways who required nasotracheal intubation were randomly divided into using lightwand group（lightwand group）（n=38） and blind intubation group（n=38）.The intubation procedure was guided by the light spot at neck in lightwand group while in blind intubation group it was guided by the patients＇ breathing sound.The intubation success rate,intubation time,changes of mean arterial pressure（MAP） and heart rate（HR） and postoperative complications of the patients were compared between two groups.Results In lightwand group,the intubation success rate（89.5%,34/38） was obviously higher than blind intubation group（71.1%,27/38）（P0.05）;the intubation time [（89.9±26.8） s] was significantly lower than blind intubation group [（134.9±32.8） s]（P0.001）;the postoperative incidence rate of pharyngalgia（14.7%,5/34） was significantly lower than blind intubation group（40.7%,11/27）（P0.05）;there were no significant differences of the incidence rates of hoarseness and epistaxis between two groups（P0.05）;the MAP values of patients were lower than blind intubation group during intubation period and 1 min after intubation,and there were no significant differences of HR of patients at different time points between two groups（P0.05）.Conclusion To the patients with difficult airways,the nasotracheal intubation using lightwand is superior to blind intubation with higher success rate,more stable haemodynamic responses,and less postoperative complications.The technique could be used as a simple and practical approach for nasotracheal intubation in difficult airways.

关 键 词：光棒 经鼻盲探插管 经鼻气管内插管 困难气道 平均动脉压 心率 

分 类 号：R562.1[医药卫生—呼吸系统]