困难气管插管患者在慢诱导麻醉下经口/鼻盲探气管插管疗效及安全性比较  

Slow induction of anesthesia effect and oxidative stress in patients with difficult endotracheal intubation and hemodynamic effects

作　　者：杨虎[1] 王天海[2] 王波[1] 陈华[1] 姜静[1] 姚国华[1] 

机构地区：[1]新疆维吾尔自治区人民医院北院麻醉科,乌鲁木齐830054 [2]新疆医科大学附属肿瘤医院麻醉科,乌鲁木齐830011

出　　处：《疑难病杂志》2017年第10期1034-1038,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016DO1C359)

摘　　要：目的观察慢诱导麻醉下经口/鼻盲探气管插管在困难气管插管患者中的效果及安全性。方法选取2005年4月—2015年5月新疆维吾尔自治区人民医院北院麻醉科及新疆医科大学肿瘤医院麻醉科行困难气管插管患者80例,以气管插管径路不同分为2组。比较经口气管插管36例(经口组)与经鼻盲探气管插管44例(经鼻组)的效果及对氧化应激和血流动力学影响,并观察2组并发症发生情况。结果经鼻组插管成功率为100.0%(44/44),高于经口组的77.8%(28/36),插管时间短于经口组(χ~2=10.864,t=9.286,P<0.01)。与插管前比较,经鼻组插管期间血糖、去甲肾上腺素、肾上腺素与经口组血糖、去甲肾上腺素均增加(P<0.05)。插管后5 min,2组去甲肾上腺素比较差异无统计学意义(P>0.05),血糖、肾上腺素比较差异仍有统计学意义(P<0.05)。与插管前比较,经口组插管期间患者HR、SBP均增加,经鼻组SBP、DBP增加,插管后5 min,2组心率收缩压乘积(RPP)比较差异无统计学意义(P>0.05),HR、BP比较差异仍有统计学意义(P<0.05)。经鼻组并发症总发生率低于经口组(11.4%vs.94.4%,χ~2=54.701,P=0.000)。结论经鼻盲探气管插管对于张口受限,尤其是颞颌关节僵直和颈椎活动受限的患者效果较好,而且操作简单易学,值得应用。Objective To observe the slow induction of anesthesia for difficult tracheal intubation effect and influence on oxidative stress and hemodynamics.Methods Between April 2005 and May 2005,80 cases of difficult tracheal intubation anesthesia patients in the Xinjiang Uygur Autonomous Region People＇s Hospital of North Hospital,according to the anesthesia line,they were randomly divided into 2 groups,compare the breath tube 36 cases （control group） and nasal intubation blind agent endotracheal intubation （nasal blind plug） 44 patients （observation group）,and the effect of oxidative stress and hemodynamic were analyzed.Results Intubation successful cases of observation group was higher than the control group （P〈0.01）,the intubation time shorter than the control group （P〈0.01）,8 intubation failure in the control group,the observation group of 0 case;Blood sugar,norepinephrine,epinephrine of the observation group were lower than the control group （P〈0.05）;SBP,DBP,HR and RPP were lower than the control group （P〈0.05）;The incidence of adverse reaction was lower than the control group （P〈0.05）.Conclusion The nasal blind plug for limited mouth opening,especially the temporal jaw joint rigidity and restricted movement of patients with cervical spine effect is good,and simple to operate,is worthy of application.

关 键 词：困难气管插管 慢诱导麻醉 氧化应激 血流动力学 

分 类 号：R614[医药卫生—麻醉学]