超声引导经鼻气管插管用于口腔颌面部手术患者的价值：与盲探法比较  

Value of ultrasound-guided nasotracheal intubation in patients undergoing oral maxillofacial surgery： a comparison with blind intubation

作　　者：王翔锋[1] 林芩[1] 李丽珍[1] 陈磊[1] 林洁[1] 

机构地区：[1]福建中医药大学附属人民医院麻醉科,福州市350004

出　　处：《中华麻醉学杂志》2015年第1期95-98,共4页Chinese Journal of Anesthesiology

基　　金：福建省卫生厅青年基金课题（2011-1-40）;福建中医药大学附属人民医院临床技术创新课题（CXTSl305）

摘　　要：目的 通过与盲探法比较,评价超声引导经鼻气管插管用于口腔颌面部手术患者的价值.方法 择期口腔颌面部手术患者40例,ASA分级Ⅰ或Ⅱ级,年龄18～75岁,体重45～90 kg,性别不限.采用随机数字表法,分为2组（n=20）：盲探组（B组）和超声组（U组）.常规气道表面麻醉和镇静后,保留患者自主呼吸,实施经鼻气管插管.B组以听呼吸气流声来调整导管前端至声门口,在气流声最强吸气相时插入气管导管;U组选用线阵探头（频率7～15 MHz）,在甲状软骨窗上可看到声门扩张和导管钢丝插入的声像.于气管插管前、气管插管成功后即刻、1、3、5 min时记录MAP、HR及SpO2,记录气管插管反应的发生情况.记录首次气管插管成功情况,气管插管次数及气管插管时间及术后咽痛、声音嘶哑等并发症的发生情况.结果 与B组比较,U组气管插管次数减少,气管插管时间缩短,首次气管插管成功率升高,气管插管失败率、咽痛和声音嘶哑的发生率降低（P＜0.05）,血流动力学指标和气管插管反应的发生率比较差异无统计学意义（P＞0.05）.所有患者对气管插管过程无知晓.结论 与盲探法比较,超声引导经鼻气管插管用于口腔颌面部手术患者可提高首次气管插管成功机率,减少气管插管次数,缩短气管插管时间,且安全、便捷,有显著临床价值.Objective To evaluate the value of ultrasound-guided nasotracheal intubation in the patients undergoing oral maxillofacial surgery by comparing with blind intubation.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr,weighing 45-90 kg,scheduled for elective oral maxillofacial surgery,were randomly divided into blind intubation group （group B,n =20） and ultrasound group （group U,n =20） according to a random number table.Nasotracheal intubation was performed after routine topical analgesia and conscious sedation.The front end of catheter was adjusted to the aditus glottidis according to the sound of respiratory air,and tracheal intubation was placed when the strongest inspiratory phase appeared in group B.A linear array probe （frequency 7-15 MHz） was used,and the images of glottis expansion and wired catheter insertion were visualized in the thyroid cartilage window in U group.Before intubation and at 0,1,3 and 5 min after successful intubation,mean arterial pressure （MAP）,HR and SpO2 were recorded.The development of responses to intubation was recorded during intubation.The successful intubation at first attempt,the number of intubation,intubation time,and postoperative complications such as sore throat or hoarseness were recorded.Results Compared with group B,the number of intubation was significantly reduced,intubation time was shortened,the rate of successful intubation at first attempt was increased,the failure rate of intubation and incidence of sore throat and hoarseness were decreased,and no significant changes were found in the parameters of hemodynamics and incidence of responses to intubation in group U.No intraoperative awareness of intubation occurred in patients.Conclusion Compared with blind intubation,ultrasound-guided nasotracheal intubation can raise the probability of successful intubation at first attempt,reduce the number of intubation,and shorten intubation time,and it is safe and convenient and provides significant value clinically for the patien

关 键 词：插管法 气管内 鼻腔 超声检查 

分 类 号：R614[医药卫生—麻醉学]