七氟醚浓度递增法在咽喉部疾病所致可疑困难气道诱导策略选择中的应用  

Application of incremental sevoflurane concentration approach in the strategy selection of patients with suspected difficult airway caused by laryngopharyngeal lesions: an observational study

作　　者：李卫星 蔡一榕 舒仕瑜 李文献 Li Weixing;Cai Yirong;Shu Shiyu;Li Wenxian(Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031

出　　处：《国际麻醉学与复苏杂志》2019年第7期649-653,共5页International Journal of Anesthesiology and Resuscitation

基　　金：上海市2017年度“科技创新行动计划”生物医药领域科技支撑项目(17441903000).

摘　　要：目的 观察七氟醚浓度递增法在咽喉部病变所致可疑困难气道诱导策略选择中的应用。 方法 收集2014年5月至2018年5月间ASA分级Ⅰ、Ⅱ级,因患咽喉部疾病需择期在全身麻醉下行咽喉部手术且存在困难气道风险的患者,包括喉阻塞Ⅰ、Ⅱ度或虽无喉阻塞症状但术前电子喉镜检查显示咽喉部新生物遮挡1/2以上声门者。具备上述条件的候选患者进行七氟醚吸入镇静,在镇静水平达Ramsay评分5分时评估气道通畅性,并给予1~3级评分,所有进入2级评分的患者成为正式研究对象,共110例,随后按随机数字表法将其分为快诱导组和慢诱导组(每组55例)。快诱导组采用静脉麻醉药+肌松药诱导插管,慢诱导组采用浓度递增法吸入七氟醚诱导后插管,不使用肌松药。分析比较两组之间插管工具选择、插管次数、插管时间及成功率以及插管过程中低氧事件发生率的差异。 结果 慢诱导组较快诱导组一次插管成功率高,插管时间短,低氧发生率更低(P<0.05)。快诱导组有3例插管失败(3/55),随后实施环甲膜穿刺通气下气管切开建立气道并顺利实施手术。 结论 在咽喉部病变所致的可疑困难气道患者,采用七氟醚浓度递增法实施慢诱导是较为理想的气管插管策略。Objective To observe the application of incremental sevoflurane concentration approach in the strategy selection of patients with suspected difficult airway caused by laryngopharyngeal lesions. Methods Patients [American Society of Anesthesiologists (ASA) Ⅰor Ⅱ] who underwent laryngopharyngeal surgery under general anesthesia with difficult airway risks from May 2014 to May 2018 were enrolled. The risk factors included degree Ⅰ to Ⅱ laryngeal obstruction or without symptoms of laryngeal obstruction but with the presence of laryngeal neoplasms which occluded more than 1/2 of the glottis through preoperative electronic laryngoscopy. All the enrolled patients were inhaled, sevoflurane, and airway assessment was performed and recorded from grades 1 to 3 when the sedation level reached 5 Ramsay score. All the patients at grades 2 or 3 were the formal participates and then these 110 patients were randomly divided into a fast induction group and a slow induction group (n=55). Intravenous anesthetics and muscle relaxants were used for intubation in the fast induction group, while incremental concentrations of sevoflurane were inhaled for intubation in the slow induction group without muscle relaxants. Both groups were compared for the intubation tool selection, intubation times, duration of intubation, successful rate and the incidence of hypoxic events during intubation. Results Compared with the fast induction group, the slow induction group showed a higher successful rate of one-time intubation, shorter intubation time and a lower incidence of hypoxia (P﹤0.05). Conclusions Incremental sevoflurane concentration approach is a relatively satisfactory tracheal intubation strategy for patients with suspected difficult airway caused by laryngopharyngeal lesions.

关 键 词：麻醉 麻醉诱导 气管插管 咽喉部病变 困难气道 

分 类 号：R614[医药卫生—麻醉学]