可视喉镜联合纤维支气管镜在高原红细胞增多症合并OSAHS患者经口气管插管中的应用  

Combined video-laryngoscopy and fiberoptic-bronchoscopy technique for transoral endotracheal intubation in patients with OSAHS and high-altitude polycythemia improves the first-pass rate

作　　者：赵石磊[1] 王洪乾[1] 刁玉刚[1] 陶信德 魏祖邦 李玉明 ZHAO Shilei WANG Hongqian DIAO Yugang TAO Xinde WEI Zubang LI Yuming(Department of Anesthesiology, General Hospital of Shenyang Military Area Command, Shenyang 110016 Department of Anesthesiology, Huzhu County People＇s Hospital of Qinghai Province, Xining 810500, China)

机构地区：[1]沈阳军区总医院麻醉科,辽宁沈阳110016 [2]青海省互助县人民医院麻醉科,青海西宁810500

出　　处：《麻醉安全与质控》2017年第4期168-171,共4页Perioperative Safety and Quality Assurance

摘　　要：目的评价可视喉镜或普通喉镜联合纤维支气管镜在高原红细胞增多症(HAPC)并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者经口气管插管中的应用,比较2种不同组合间的优劣。方法拟行全身麻醉的HAPC并OSAHS患者60例,随机分为2组。普通喉镜联合纤维支气管镜组(A组,n=30)和可视喉镜联合纤维支气管镜组(B组,n=30)。记录2组患者一次性插管成功率、插管次数、插管时间、操作时患者出现脉搏血氧饱和度下降例数、血流动力学变化及相关并发症情况。结果 A组患者中26例一次插管成功;4例患者二次插管成功,B组患者均一次插管成功。A组患者有6例在插管过程中发生脉搏血氧饱和度下降,B组2例,优于A组。B组患者插管一次成功率优于A组,插管时间较A组缩短,插管时心率及血压变化与A组相比差异无统计学意义。两组患者在麻醉管理及术后随访均未发生明显相关并发症。结论与普通喉镜联合纤维支气管镜相比,可视喉镜联合纤维支气管镜缩短了操作时间,提高了一次成功率,为双镜联合快诱导气管插管方法中的更优方案。Objective The aim of the study was to evaluate the performance between the combined techniques of video-laryngoscopy/ fiberoptic bronchoscopy and direct laryngoscopy/fiberoptic bronchoscopy for transoral endotracheal intubation in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and with High-altitude polycythemia （HAPC）. Methods Sixty patients with HAPC and OS- AHS undergoing general anesthesia were randomly divided into 2 groups ： the group of direct laryngoscopy/fiberoptic bronchoscopy （ group A, n = 30） and the group of video-laryngoscopy/fiberoptic bronchoscopy （group B, n = 30）. The data, including the rate of success, the attempts of intubation, operating time, the pulse-oximetry （ SpO2 ）/hemodynamic measurements during the operation and the outcomes of the intubation, were compared between groups. Results Twenty-six/thirty patients in group A were successfully intubated at the first attempt, yet the other 4 were intubated at the second attempt. All 30 patients in group B were successfully intubated at the first attempt. 6/30 patients in group A and 2/30 patients in group B had declined SpO2 during intubation. Compared to the corresponding values in group A, the success rate of endotracheal intubation was significantly higher ; and the time for intubation was markedly shorter in group B, but the corresponding values of blood pressure and heart rate did not differ between the two groups. No significant endotracheal intubation-related complications were observed in either group during and after anesthesia. Conclusion Compared with direct laryngoseopy/fiberop-tic bronchoscopy, video-laryngoscopy/fiberoptic bronchoscopy has a higher first-pass rate and shorter intubation time.

关 键 词：高原红细胞增多症 阻塞性睡眠呼吸暂停低通气综合征 可视喉镜 纤维支气管镜 

分 类 号：R614[医药卫生—麻醉学]