光棒引导气管插管在鼾症患儿麻醉中的应用价值  

Application value of lightwand guided tracheal intubation in anesthesia for children with obstructive sleep apnea syndrome

作　　者：王来 杜健儿[1] 赵璇 石学银[1] WANG Lai;DU Jian-er;ZHAO Xuan;SHI Xue-yin(Department of Anesthesiology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Anesthesiology,Tenth People’s Hospital,Tongji University,Shanghai 200072,China)

机构地区：[1]上海交通大学医学院附属新华医院麻醉与重症医学科,上海200092 [2]同济大学附属第十人民医院麻醉科,上海200072

出　　处：《中国临床医学》2018年第5期782-785,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨光棒引导气管插管在睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患儿的临床应用,比较其与普通喉镜的插管效果和安全性。方法:选择2~9岁择期行扁桃体切除术和(或)腺样体吸割术的OSAS患儿40例,ASA分级Ⅰ～Ⅱ级,随机分为光棒组(L组,n=20)和喉镜组(C组,n=20)。分别比较患儿入室后(T_1),诱导后(T_2),插管后1min(T_3)、3min(T_4)、5min(T_5)的心率(HR)、平均动脉压(MAP)和脉搏氧饱和度(SpO_2)变化,记录插管时间、一次插管成功率、口腔黏膜和牙齿损伤并发症的发生情况。结果:L组插管时间明显低于C组(P<0.05)。L组的一次插管成功率明显高于C组(100%vs 90%)(P<0.05)。插管后1min L组HR显著低于C组(P<0.05)。C组插管后1min的MAP较诱导后明显增高(P<0.05)。C组插管后1min、3min、5min的HR较诱导后明显增高(P<0.05)。L组插管后1min的MAP较诱导后有增高趋势,但无统计学差异,其HR在插管后1min、3min较诱导后显著增高(P<0.05)。口腔黏膜损伤仅C组出现1例。结论:与普通喉镜相比,光棒插管具有成功率高、插管时间短、口腔黏膜损伤小、对血流动力学影响较轻的优点,可以安全用于鼾症患儿气管插管。Objective:To investigate the safety and clinical efficacy of lightwand guided tracheal intubation in anesthesia for children with obstructive sleep apnea syndrome(OSAS),and compare it with direct laryngoscope method.Methods:40 children aging from 2 to 9 years old were included in this study.They suffered from OSAS and would undergo adenoidectomy.During the clinical trial,the sick children were randomly divided into two groups:lightwand group(group L,n=20)and direct laryngoscope group(group C,n=20).The changes of heart rate(HR),mean arterial pressure(MAP),and pulse oxygen saturation(SpO 2)when the children entered into the operation room(T 1),after induction(T 2),as well as 1 min(T 3),3 min(T 4),5 min(T 5)after intubation were recorded.Besides,the intubation success rate for the first time,the intubation time,the cases of oral mucosal injury,and teeth damage were recorded.Results:The intubation time in group L was significantly shorter than that in group C(P<0.05).The success rate of the first time intubation in group L was significantly higher than that in group C(100%vs 90%,P<0.05).One minute after intubation,HR for patients in group L were significantly lower than that in group C(P<0.05).In group C,MAP at 1 min after intubation was significantly higher than that of T 2(P<0.05).HR at 1 min,3 min,and 5 min after intubation was significantly higher than that of T 2(P<0.05).And in group L,MAP at 1 min after intubation was higher than that of T 2 without significant difference.HR at 1 min and 3 min after intubation was significantly higher than that of T 2(P<0.05).Only one case of oral mucosal injury was found in group C.Conclusions:Compared with general laryngoscope,lightwand guided tracheal intubation has the advantages of higher success rate of intubation for the first time,shorter intubation time,less damage to the oral mucosa,and less influence on hemodynamics for pediatric patients with OSAS.Lightwand can be safely and effectively used in pediatric anesthesia.

关 键 词：光棒 喉镜 小儿 睡眠呼吸暂停综合征 气管插管 

分 类 号：R725.6[医药卫生—儿科]