动态超声成像技术在中度肥胖患者气管内插管中的应用  

Clinical research of dynamic ultrasonography technology used to confirm the endotracheal tube position in moderately obese patients

作　　者：吕瑞兆 景桂霞[1] 王珊[2] 严军[1] 

机构地区：[1]西安交通大学第一附属医院麻醉科,710061 [2]宁夏医科大学总医院麻醉科

出　　处：《临床麻醉学杂志》2016年第1期42-45,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨动态超声成像技术用于确认中度肥胖患者气管内插管。方法选择择期行外科手术并接受气管内插管的中度肥胖患者49例,男34例,女15例,年龄18~67岁,BMI 30~35kg/m2,ASAⅠ或Ⅱ级,MallampatiⅢ或Ⅳ级。按随机数字表法将患者随机分为听诊组（C组,n=24）和动态超声成像组（U组,n=25）。所有患者麻醉诱导后采用普通喉镜插入气管内导管,C组和U组分别通过听诊法或动态超声成像法确认气管内插管,并最终由纤维支气管镜确认并调整气管导管的位置。记录两组气管内插管成功率、确认气管内插管的灵敏度、特异度、所需时间,并观察U组相关超声指征出现的频率。结果两组气管内插管成功率差异无统计学意义。U组确认气管内插管的灵敏度、特异度明显高于C组（P〈0.05）;U组确认气管内插管所需时间明显短于C组（P〈0.01）。U组在气管内共振波消失出现频率、气管内导管回声出现频率明显高于在食管内（P〈0.05）,侧后方高回声出现频率明显低于在食管内（P〈0.05）。结论动态超声成像技术确认中度肥胖患者气管内插管更快捷、可靠。Objective To study the dynamic ultrasonography technology used to confirm the endotracheal tube position in moderately obese patients. Methods Forty nine moderately obese patients BMI 30-35 kg/m2, male 34 cases, female 15 cases, aged 18-67 years, ASA grade I or H undergoing elective surgery with endotracheal intubation were enrolled. Patients with Mallampati score ranged Ⅲ to Ⅳ were randomly divided into auscultation group（group C,n=24） or dynamic ultrasonography group （group U, n = 25）. Endotracheal intubation was implemented after induction with Miller standard laryngoscope.The endotracheal tube position was first confirmed by auscultation or dynamic ultrasonography technology respectively, and then confirmed and adjusted under fiberoptic bronchoscopy. The successful endotracheal intubation rate of two groups, sensitivity and specificity of two technologies to confirm the endotracheal tube position, the time required, and the frequency of ultrasonic indications within group U were recorded.Results There was no significant difference in suc- cess rate of endotraeheal intubation between the two groups. For the sensitivity and specificity of con- firming endotracheal tube position, group U was statistically higher than that of group C（P〈0.05）. Group U need less time to confirm the position of endotracheal tube than group C （P〈0.01）. In group U, there was significantly higher frequency of resonance wave disappeared and echo appeared （P〈0. 05）in the trachea than in the esophagus, and lower frequency of high echo appeared postero- lateral in the trachea than in the esophagus （P 〈0. 05）. Conclusion The dynamic ultrasonography technology was much more efficient and reliable to confirm the endotracheal tube position in moderately obese patients.

关 键 词：气管内插管 超声影像 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]