4种方法确定气管导管位置的效果比较  

A comparison of effects of four different methods to locate tracheal tube

作　　者：齐乐[1,2] 刘荣[1] 李寿春[1] 吕少君[1] 翁浩[1] 

机构地区：[1]上海交通大学第六人民医院南院(上海市奉贤区中心医院)麻醉科,201400 [2]包头市中心医院麻醉科,内蒙古自治区包头014010

出　　处：《中华危重病急救医学》2016年第9期812-816,共5页Chinese Critical Care Medicine

基　　金：上海市医药卫生科研课题（201440571）;国家实用新型专利（ZL200820190168.3）

摘　　要：目的比较改良颈部透光法与导管厘米刻度法、气囊后标记线法、纤维支气管镜（纤支镜）法确定气管导管插入位置的效果。方法采用前瞻性随机对照研究方法，选择2015年1月至3月上海市奉贤区中心医院收治的120例符合美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级进行全麻经口插管的成人患者，麻醉诱导后直接用喉镜插入导管。按随机数字表法将患者分为4组（n=30），分别采用导管厘米刻度法、气囊后标记线法、纤支镜法和改良颈部透光法（将自制光纤引导红色激光导管定位器用于导管定位）确定导管位置。插管时各组患者依次采用屈曲位、中立位、后仰位，测量3种头颈位时导管顶端至隆突和气囊后缘至声门的距离；记录各组导管位置不良的发生情况。结果4组患者性别、年龄、体质指数差异均无统计学意义。采用气囊后标记线法确定导管位置的30例患者中有6例在直接喉镜下未见到声门，未能完成定位；其他3种方法均按照要求完成定位。①患者由屈曲位变为后仰位时，隆突一管尖距离逐渐延长，而气囊一声门距离逐渐缩短；当患者处于屈曲位和后仰位时，导管厘米刻度法测量隆突-管尖距离较纤支镜法明显缩短（em：1．44±1．14比2．11±0．54，3．01±1．18比3．80±0．71，均P〈0．05），也较改良颈部透光法略有缩短（om：1．44±1．14比1．93±0．81，3．01±1．18比3．45±O．91，均P〉0．05）；当患者处于中立位、后仰位时，导管厘米刻度法测量气囊-声门距离较改良颈部透光法、气囊后标记线法、纤支镜法明显延长（em：3．07±1．08比2．28±0．76、2．29±0．90、2．49±0．86，2．64±0．94比1．82±0．72、1．81±0．94、2．02±0．91，均P〈0．05）。与纤支镜法比较，改良颈部透光法在3种体位下测量的隆突-管尖和气囊-声门的距离均较短，但差异无统计学意义。�Objective To compare the efficacy of four different methods to locate tracheal tube in the tracheal： modified transillumination method, 21/23 cm rule, marked the intubation at a distance, and fiberoptic bronchoscope. Methods A prospective randomized controlled trial was conducted. 120 endotracheally intubated adult patients with American Society of Anesthesiologists （ASA） classification I - lI and admitted to Central Hospital of Fengxian in Shanghai from January to March 2015 were enrolled. The patients were randomly divided into four groups （n = 30） and located by 21/23 cm rule, marked the intubation at a distance, fiberoptic bronchoscope and modified transillumination method （using homemade locator guided by a red laser fiber to position the depth of tube） respectively. An endotracheal tube was inserted and measured the distance of the tube tip to the carina （TTC）, vocal cords to tracheal tube cuff （VC-TC） in three different neck positions, i.e. neck in flexion, neutral, and extension position. The number of improper position in four groups was recorded. Results There were no significant differences in gender, age, and body mass index among the four groups. Six of the 30 patients using marked tracheal tuba method failed to find vocal cords with laryngoscope, while the other three methods all completed successfully. （3） From neck flexion to extension, TFC was gradually increased, while VC-TC was gradually decreased. In neck flexion and extension positions, TYC distance in the 21/23 cm rule group was significantly shorter than that in the fiberoptic bronchoscope group （cm： 1.44± 1.14 vs. 2.11±0.54, 3.01 ± 1.18 vs. 3.80±0.71, both P 〈 0.05）, and the distance was also shorter than that in modified transillumination method group （cm： 1.44± 1.14 vs. 1.93 ±0.81, 3.01 ± 1.18 vs. 3.45±0.91, both P 〉 0.05）. VC-TC distance in the 21/23 cm rule group was significantly longer than that in the modified transillumination, the marked intubation, and the fiberoptic hronchoscope

关 键 词：气管导管位置 颈部透光法 导管厘米刻度法 气囊后标记线 纤维支气管镜 

分 类 号：R614[医药卫生—麻醉学]