不同插管方法引导双腔支气管导管在预测困难气道患者胸外科手术麻醉插管中的应用效果  

Application effect of different intubation methods in guiding double lumen endobronchial tube for the thoracic surgery anesthesia intubation in patients with predictable difficult airway

作　　者：于品仙 林丽娟[1] 王竹[1] YU Pin-xian;LIN Li-juan;WANG Zhu(Department of Anesthesiology,Central People′s Hospital of Zhanjiang,Guangdong Province,Zhanjiang 524045,China)

机构地区：[1]广东省湛江中心人民医院麻醉科

出　　处：《中国当代医药》2020年第2期163-167,171,共6页China Modern Medicine

摘　　要：目的比较不同插管方法引导双腔支气管导管(DLT)在预测困难气道患者胸外科手术麻醉插管中的应用效果。方法选取2015年3月~2018年12月在我院行胸外科手术麻醉前预测评估为困难气道的69例患者作为研究对象,按照随机数字表法将其分为A组(23例)、B组(23例)和C组(23例)。三组患者分别采用直接喉镜、可视喉镜、纤维支气管镜进行DLT插管,比较三组患者的插管时间、一次性插管成功率、术中低氧血症发生率、术中DLT移位率及插管术后并发症发生情况,并记录三组患者麻醉前(T0)、麻醉诱导后即刻(T1)、插管后即刻(T2)、插管后1 min(T3)、插管后5 min(T4)的血流动力学指标[平均动脉压(MAP)、心率(HR)]。结果C组患者的插管时间短于A组和B组,差异有统计学意义(P<0.05);C组患者的一次性插管成功率高于A组,差异有统计学意义(P<0.05);C组患者的术中低氧血症发生率低于A组,差异有统计学意义(P<0.05);C组患者的术中DLT移位率低于A组和B组,差异有统计学意义(P<0.05);C组患者插管后并发症总发生率低于A组,差异有统计学意义(P<0.05)。三组患者T0、T1时的MAP和HR比较,差异无统计学意义(P>0.05);C组患者的MAP在T2、T3、T4时均低于A组和B组,差异有统计学意义(P<0.05);C组患者的HR在T2时低于A组和B组,差异有统计学意义(P<0.05);三组患者T3、T4时的HR比较,差异无统计学意义(P>0.05)。结论纤维支气管镜直视引导DLT在预测困难气道患者胸外科手术麻醉插管中的应用是安全可行的,其插管时间短,插管后并发症少,血流动力学波动辐度小,定位精准,术中低氧血症的发生率低,值得临床在胸外科手术中推广和应用。Objective To compare the application effect of different intubation methods in guiding double lumen endobronchial tube(DLT)for the thoracic surgery anesthesia intubation in patients with predictable difficult airway.Methods From March 2015 to December 2018,69 patients with predictable difficult airway before anesthesia for thoracic surgery in our hospital were selected as the study subjects.They were divided into group A(23 cases),group B(23 cases)and group C(23 cases)according to the random number table method,three groups of patients were respectively given direct laryngoscope,video laryngoscope,fiberoptic bronchoscopy for DLT intubation.The intubation time,the success rate of one-time intubation,the incidence of intraoperative hypoxemia,the intraoperative DLT translocation rate,and the incidence of postoperative complications after intubation in the three groups were compared.The hemodynamic parameters(mean arterial pressure[MAP],heart rate[HR])in three groups of patients were recorded before anesthesia(T0),immediately after induction of anesthesia(T1),immediately after intubation(T2),1 minute after intubation(T3),and 5 minutes after intubation(T4).Results The intubation time in group C was shorter than that in group A and group B,and the difference was statistically significant(P<0.05).The success rate of one-time intubation in group C was higher than that in group A,and the difference was statistically significant(P<0.05).The incidence of intraoperative hypoxemia in group C was lower than that in group A,and the difference was statistically significant(P<0.05).The intraoperative DLT translocation rate in group C was lower than that in group A and group B,and the difference was statistically significant(P<0.05).The total incidence of postoperative complications in group C was lower than that in group A, with statistically significant difference (P<0.05). There were no significant differences in MAP and HR at T0 and T1 among the three groups (P>0.05). The MAP of patients in group C was lower than that in group

关 键 词：不同插管方法 双腔支气管导管 困难气道 胸外科手术 麻醉插管 

分 类 号：R614[医药卫生—麻醉学]