纤支镜引导经鼻气管插管置入支气管阻塞器在单肺通气中的应用  

Clinical application of Fiberoptic bronchoscopy-guided nasotracheal intubation placed the bronchial obstruction during one lung ventilation

作　　者：居霞[1,2] 李元海[1] 王胜斌[2] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022 [2]安徽医科大学附属安庆医院麻醉科,安庆246003

出　　处：《安徽医科大学学报》2014年第4期551-553,共3页Acta Universitatis Medicinalis Anhui

基　　金：安徽省卫生厅临床医学应用技术项目(编号:2008A023)

摘　　要：30例无法经口气管插管的患者需行单肺通气的手术,采用健忘镇痛慢诱导纤支镜(FOB)引导经鼻气管插管置入支气管阻塞器行单肺通气。记录患者入室时(T0)、环甲膜穿刺时(T1)、FOB引导气管导管进入气管时(T2)、支气管阻塞器充气即刻(T3)、支气管阻塞器置入成功后5 min(T4)各时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),同时记录气管插管时间以及一次成功率;置入阻塞器时间以及一次成功率;术中肺隔离效果;术后随访有无插管时记忆;术后带管时间;比较单肺通气前后的气道压的变化;术后声嘶、咽痛发生率及严重情况。30例患者29例一次气管插管成功,成功率为96.7%(29/30),操作时间55s^4 min。阻塞器置入一次成功率为100%(30/30),操作时间20~30 s。与T0比较,各时间点的MAP、HR轻度增加,但差异无统计学意义(P>0.05),各时间点SpO2比较差异无统计学意义(P>0.05),患者术中术侧肺隔离完好,术中单肺通气前后气道压力有一定变化(P<0.05),但气道压力基本维持在2.4~3.3 kPa,PetCO24.7~5.3 kPa。术后随访30例患者对插管过程均无记忆,带管时间平均超过10 h且耐受良好,患者无1例出现声嘶、咽痛等不良反应。Thirty patients undergoing special difficult intubation were induced with slow amnesia analgesia by Fi- beroptic bronchoscopy-guided nasotracheal intubation placed the bronchial obstruction during one-lung ventilation. Mean arterial pressure （MAP）, heart rate （HR） and SpO2 were recorded at T0, T1, T2, T3 and T4, meanwhile in- tubation time and the rate of successful intubation, as well as placed the bronchial obstruction and the rate of suc- cessful intubation were reeored. The lung was isolated effectively in the intraoperative period. The airway pressure was monitored during operation. All the patients were followed up postoperative for adverse effects such as the intu- bation memory, intubation time, sorethroat or hoarseness. The rate of successful intubation placement at first at- tempt was 96.7% （29/30）, placement time was 55 s -4 min, one of the patients was placed through the tracheos- tomy bronchial obstruction. The rate of successful bronchial obstruction placement at first attempt was 100% （30/ 30） , placement time was 20 -30 s. Compared with To, there was no significant difference in MAP, HR and SpO2 at T1 , T2, T3 and T4. At OLV the airway pressure was significantly higher than that at TLV. All patients with opera- tion-side lung were separated effectively. Thirty patients had no memory of the intubation process, and they well to- lertated with keeping intubation time more than 10 h , all patients were not sore throat or hoarseness in the postoper- ation.

关 键 词：纤支镜 经鼻气管插管 健忘镇痛 支气管阻塞器 

分 类 号：R608[医药卫生—外科学] R655.3[医药卫生—临床医学]