三维重建成像技术指导硬质纤维气管镜行困难气管插管的效果观察  

The Effect of CT Three-dimensional Reconstruction Technique in Guiding Difficult Tracheal Intubation with Rigid Fiber Bronchoscope

作　　者：王金保[1] 张昊仟 张在旺[1] 汤龙信[1] 底妍 WANG Jin-bao;ZHANG Hao-qian;ZHANG Zai-wang;TANG Long-xin;DI Yan(Department of Anaesthesiology,980 Hospital of PLA Joint Logistics Surport Forces,Shijiazhuang,050082,China;Clinical Medicine Undergraduate,Class of 2017,Binzhou Medical University,Binzhou,Shandong 264003,China)

机构地区：[1]联勤保障部队第九八〇(白求恩国际和平)医院麻醉科,石家庄050082 [2]滨州医学院,山东滨州264003

出　　处：《临床误诊误治》2019年第8期55-59,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省科技支撑计划项目(No12277736);河北省卫计委2014医学重点研究项目(ZL20140179)

摘　　要：目的 观察三维重建成像技术指导硬质纤维气管镜行困难气管插管的效果。方法 选取符合纳入及排除标准的颈项强直、颈部外伤需制动或严重颈椎病颈椎固定行择期手术44例,采用随机数字表法随机将其分为试验组和对照组两组各22例。试验组采用塑形后硬质纤维气管镜进行气管插管,对照组采用原始角度硬质纤维气管镜进行气管插管。观察比较两组CT成像上气管测量角、传统困难气道评估指标、首次气管插管成功率、气管插管时间、不同时间心率血压乘积(rate-pressure product, RPP)及气管插管并发症发生情况。结果 两组气管插管成功率均为100%。两组CT成像上气管测量角、传统困难气道评估指标、气管插管时间及不同时间RPP比较差异均无统计学意义( P >0.05)。试验组首次气管插管成功率为95.45%,显著高于对照组首次气管插管成功率72.73%,差异有统计学意义( P <0.05)。试验组术后出现咽部疼痛3例,气管插管并发症发生率13.64%,对照组术后出现咽部疼痛4例,气管插管并发症发生率18.18%,两组气管插管并发症发生率比较差异无统计学意义( P <0.05)。结论 CT三维重建技术对硬质纤维气管镜行困难气管插管具有一定指导意义。Objective To observe the effect of CT three-dimensional reconstruction technique in guiding the difficult tracheal intubation with rigid fiber bronchoscope. Methods A total of 44 patients who met the inclusion and exclusion criteria and underwent elective surgery for neck stiffness, cervical spinal immobilization after trauma, or severe cervical spondylosis with fixed cervical spine were enrolled in this study. They were randomly divided into two groups: experimental group ( n =22) and control group ( n =22) according to random number table method. The experimental group was intubated using a rigid bronchoscope after shaping, and the control group was treated with an original rigid bronchoscope for endotracheal intubation. The angle of trachea on CT imaging, indicators for evaluation of difficult airway, initial success rate of intubation, length of intubation, rate-pressure product(RPP)at different time points and intubation-related complications were recorded. Results The success rate of intubation in both groups were 100%. There was no significant difference in angle of trachea on CT imaging, indicators for evaluation of difficult airway, initial success rate of intubation and RPP at different time points ( P <0.05). The initial success rate of intubation was 95.45% in experimental group, which was significantly higher than that (72.73%) in the control group ( P < 0.05). There were 3 cases of pharyngeal pain in the experimental group, and the incidence of intubation-related complications was 13.64%. In contrast, there were 4 cases of pharyngeal pain in the control group, and the incidence of intubation-related complications was 18.18%. The incidence of intubation-related complication in the two groups did not differ significantly ( P <0.05). Conclusion CT three-dimensional reconstruction technique is of significance in guiding difficult tracheal intubation using rigid fiber bronchoscope in patients. Conclusion CT three-dimensional reconstruction technique is of significance in guiding difficult tracheal intuba

关 键 词：CT三维重建技术 硬质纤维气管镜 颈椎固定 困难气管插管 

分 类 号：R615[医药卫生—外科学]