纤维支气管镜引导清醒气管插管在强直性脊柱炎颈椎畸形手术患者中的应用  

Application of Fiberoptic Bronchoscopy Guided Awake Intubation in Ankylosing Spondylitis-induced Trachelokyphosis Surgery

作　　者：卢承志[1] 张文龙[1] 于美华[1] 何丽云[1] 刘建东[1] 

机构地区：[1]解放军175医院麻醉科,福建漳州363000

出　　处：《医疗卫生装备》2013年第8期76-77,共2页Chinese Medical Equipment Journal

摘　　要：目的:观察纤维支气管镜(FOB)引导清醒经鼻气管插管在强直性脊柱炎颈椎后凸畸形手术患者中的应用效果。方法:择期在气管内全麻下行颈椎截骨矫形手术患者8例,气管内充分表面麻醉后,静脉给予右美托咪啶(dexmedetomi-dine,Dex)1μg/kg后以0.6μg.kg-1.h-1持续静脉输注10 min后行FOB引导经鼻清醒气管插管,记录入室后(T1)、插管前即刻(T2)、气管导管进入声门即刻(T3)、插管后2 min(T4)、插管后5 min(T5)和插管后10 min(T6)时的SBP、DBP、HR;记录气管插管的次数、时间及成功率;术后随访患者有无咽喉疼痛、声音嘶哑、吞咽困难等不良反应。结果:本组8例患者均一次插管成功;插管时间为(2.7±1.5)min;T3～T5时的SBP、DBP、HR均较T1明显升高(P<0.05),T5、T6时又趋于稳定状态,但与T1比较差异无统计学意义(P>0.05);操作过程中,所有患者SpO2均保持在97%以上。术后随访均无咽喉疼痛、声音嘶哑、吞咽困难等不良反应和任何不良记忆。结论:纤维支气管镜(FOB)引导清醒经鼻气管插管在强直性脊柱炎颈椎后凸畸形手术患者中应用,插管成功率高、速度快、并发症少。To study the application of fiberoptic bronchoscopy（FOB） guided awake inbubation to ankylosing- spondylitis-induced trachelokyphosis surgery. ~ Totally 8 cases of elective endotracheal cervical osteotomy with general anesthesia were selected as the subjects, who underwent dexmedetomidine（Dex） infusion with the dose of 1 μg/kg and then 10-min Dex transfused with the dose of 0.6 μg.kg-l.h-I after surface anesthesia. Then after FOB-guided awake nasotracheal intubation, the values of SBP, DBP and HR were recorded at the moments while entering the room（Tl）, before the intubation（T2）, instantly after the intubation（T3）, 2 minutes after the intubation（T4）, 5 minutes after the intubation（Ts） and 10 minutes after the intubation（T6）, along with the times, duration and success rates of the intubation. Post-operation follow- up was performed for sore throat, hoarse voice, dysphagia and etc. ~ The intubations had the success rate at the first time 100% and the durations within（2.7±1.5） min. The values of SBP, DBP and HR at the moments of/＇3, /＇4 and/＇5 were all higher than those at /＇1 with/9〈0.05, and were stable at T5 and T6 while not significantly different from those at Tl with P〉 0.05. The values of SpO2 of all the patients were all kept more than 97%, and there was no any adverse effects such as sore throat, hoarse voice, dysphagia found during the operation. FOB-guided awake intubation in ankylosing- spondylitis-induced trachelokyphosis surgery has a high success rate, a high speed and few complications for the intubation.

关 键 词：颈椎畸形手术 纤维支气管镜 经鼻清醒气管插管 

分 类 号：R687.3[医药卫生—骨科学] R614[医药卫生—外科学]