可视喉镜联合纤维支气管镜在困难气道患者的使用价值  

Application of video laryngoscope combined with fiberoptic bronchoscope for awake intubation in patients with difficult airway

作　　者：邵雪泉[1] 徐玲[1] 余洁[1] 潘中心[1] 江秀清[1] 王建[1] 程群[1] 汪华娟 

机构地区：[1]衢州市人民医院麻醉科,324000

出　　处：《浙江医学》2015年第19期1604-1606,1610,共4页Zhejiang Medical Journal

摘　　要：目的观察困难气道患者采用可视喉镜联合纤维支气管镜(FOB)引导经口腔清醒气管插管的临床价值。方法选择择期手术的困难气道患者100例,采用随机数字表法分为可视喉镜+钢丝塑形气管导管组(M组)和可视喉镜联合FOB组(MF组),每组各50例。两组患者在充分表面麻醉的基础上,采用静脉恒速泵输注右美托眯啶1μg/kg(10min内注射完毕),保留自主呼吸下行气管插管。观察并比较两组患者麻醉诱导前(基础值)、诱导后即刻、气管插管后即刻和插管后1min的平均动脉压(MAP)、心率(HR)及脉搏氧饱和度(SpO_2),并记录首次气管插管成功率、2次及2次以上操作成功的例数及插管时间,同时记录插管期的相关并发症,术后咽喉疼痛、声音嘶哑及对气管插管的记忆情况。结果两组患者麻醉诱导后即刻的MAP、HR明显低于基础值,差异均有统计学意义(均P<0.05);两组患者仅M组在插管后1min的MAP均高于基础值,差异均有统计学意义(P<0.01)。与M组比较,MF组首次气管插管成功率高,2次及2次以上插管尝试例数减少、气管插管时嘴唇、牙龈及咽喉软组织损伤发生率降低,组间比较差异均有统计学意义(均P<0.05)。结论与可视喉镜组比较,对于一些特别的困难气道患者,可视喉镜联合FOB有助于提高气管插管成功率。Objective To assess the application of video laryngoscope combined with fiberoptic bronchoscope（FOB） for awake intubation in patients with difficult airway. Methods One hundred patients with difficult airways undergoing awake intubation were randomly divided into video laryngoscope plus shaped tracheal catheter group （group M, n=50） and video laryngoscope combined with fiberoptic bronchoscope group （group MF, n=50）. After topical anesthesia, a loading dose of dexmedetomidine 1.0μ g/kg was infused, and the awake intubation was performed with spontaneous breathing. MAP, HR and SpO2 were recorded before induction, pre-intubation, intubation, lmin after intubation. Success rate of tracheal intubation in first time, and the duration and the amount of success of tracheal intubation 〉2 times were recorded. Side effects during intubation including postoperative sore throat, hoarseness and unpleasant memories were also recorded. Results The MAP and HR instantly after introduction in both groups were significantly lower than baseline （P〈0.05）. The MAP 1 min after intubation was significantly higher than baseline in group M （P〈0.01）. Compared with group M, patients in group MF demonstrated significantly higher success rate of intubation in first time, less cases of repeated intubations for two or more attempts, lower incidence of lip, gingival, and soft tissue injuries（P〈0.05）. Conclusion Video laryngoscope combined with fiberoptic bronchoscope can raise the success rate of tracheal intubation in difficult airway as compared with video laryngoscope alone.

关 键 词：困难气道 可视喉镜 纤维支气管镜 清醒插管 

分 类 号：R614[医药卫生—麻醉学]