视可尼喉镜在颈椎损伤患者经鼻气管插管中的应用  

The Application of Shikani Optical Stylet for Nasotracheal Intubation in Patients with Cervical Spine Trauma

作　　者：李准民[1] 王析宇[1] 吴奇伟[1] 张福民[1] 

机构地区：[1]中国人民解放军第163中心医院麻醉科,长沙410003

出　　处：《中国现代手术学杂志》2013年第5期330-333,共4页Chinese Journal of Modern Operative Surgery

摘　　要：[摘要]目的评价视可尼喉镜用于颈椎损伤患者经鼻气管插管的效果。方法拟在经鼻气管插管全麻下行择期手术的颈椎损伤患者38例，ASAI～Ⅱ级，年龄18～68岁。所有患者均采用颈托固定头颈于中立位，全麻诱导后，应用视可尼喉镜引导经鼻气管插管。记录插管成功率、插管时间、插管并发症、麻醉诱导及插管前后的血流动力学改变。结果插管成功率100％（38／38），一次插管成功率为89．5％（34／38），平均插管时间为（65．0±14．2）s。麻醉诱导后（他）SBP、DBP、HR较麻醉诱导前（T1）明显降低（P〈0．05）；气管插管毕（T3）SBP、DBP、HR较麻醉诱导后（T2）明显升高（P〈0．05），但SPl3仍低于麻醉诱导前（T1）（P〈0．05），而DBP、HR与诱导前比较无显著性差异（P〉0．05）；插管后2min（T4），SBP、DBP、HR与气管插管毕（T3）比较有明显下降（P〈0．05），但与诱导后（他）比较无显著性差异（P〉0．05）。插管所致出血的发生率为47．4％（18／38），程度轻微；术后24h内回访无明显鼻咽部疼痛或声音嘶哑病例。结论视可尼喉镜引导经鼻气管插管用于颈椎损伤患者效果满意，且其携带方便、操作简便，是此类患者气管插管的较好选择。Objective To evaluate the efficacy of Shikani Optical Stylet （SOS） for nasotracheal intubation in patients with cervical spine trauma. Methods Thirty-eight patients, ASAI ~ II, between 18 and 68 years old, presenting for surgery under general anesthsia requiring nasotracheal intubation, were included in this study. Each patient was provided in-line axial stabilization of the head and neck with neck collar. Intubation was per- formed under guidance of SOS after general anesthetic induction. The first attempt and overall success rates of in- tubation, intubation time, complications of intubation were recorded. Hemodynamics was measured before anes- thesia induction （ baseline values）, after anesthesia induction, immediately after intubation and 2 minutes after in- tubation. Results The overall success rate of intubation was 100% （38/38） and the first attempt success rate of intubation was 89.5 % （ 34/38 ）. The average time of intubation was （65.0 ± 14.2） s. Immediately after intuba- tion, SBP, DBP and HR increased significantly compared to postinduction values （ P 〈 0.05 ）, but SBP was still lower than baseline values （P 〈 0.05 ）, and DBP and HR were not significantly different from the baseline values （ P 〉 0.05 ）. The incidence of hemorrhage associated with intubation was 47.4% , and the extent of hemorrhage was slight. The complications of intubation such as sore throat and hoarseness were not found at postoperative visit. Conclusion The Shikani Optical Stylet, which is portable and easy to operate, might be a good alter- native for nasotracheal intubation in patients with cervical spine trauma by providing satisfied efficacy.

关 键 词：喉镜 支气管镜 颈部损伤 导管插入术 外周 

分 类 号：R614.2[医药卫生—麻醉学]