探讨头高位联合托下颌改良快顺序诱导插管的效果  

Safety of modified rapid sequence induction intubation in head-up posture combined jaw thrust

作　　者：鲁婷[1] 于颖颖[1] 孙杰[1] 丁正年[1] 蒋金娣[1] LU Ting;YU Yinyin;SUN Jie;DING Zhengnian;JIANG Jindi(Department of Anesthesiology,the People's Hospital of Jiangsu Province,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2020年第5期437-440,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨急诊饱胃患者采用头高位20°~30°联合呼吸暂停期间托下颌开放气道的安全性。方法急诊普外科手术患者197例,男96例,女101例,年龄18~80岁,体重45~75 kg,ASAⅠ-Ⅲ级,随机分为两组:改良快诱导组(M组,n=99)和传统快诱导组(R组,n=98)。充分预给氧后,M组头高位20°~30°行快顺序诱导,呼吸暂停期间托下颌开放气道;R组平卧位下行快顺序诱导,同时行环状软骨压迫,两组均未机械辅助通气。若SpO2<92%,手控小潮气量辅助呼吸维持氧合。记录喉镜暴露时间、插管时间、无通气时间、最低SpO2、SpO2从100%降至99%所需时间。记录呛咳、反流、误吸、吸入性肺炎等并发症的发生情况。结果两组喉镜暴露时间、插管时间、无通气时间差异无统计学意义。与R组比较,M组SpO2最低值明显高于R组(P<0.01),SpO2从100%降至99%所需时间明显长于R组(P<0.05)。两组呛咳、反流、误吸、吸入性肺炎等并发症发生率差异无统计学意义。结论头高位20°~30°联合呼吸暂停期间托下颌开放气道的改良快顺序诱导气管插管不仅可以有效预防反流误吸,而且可以维持较高的SpO2,延长无通气安全时间。Objective To investigate the safety of head-up posture(20°-30°)combined with jaw thrust during apnea time of emergency patients of full-stomach.Methods One hundred and ninety-seven patients scheduled for emergency general surgeries,96 males and 101 females,aged 18-80 years,weighing 45-75 kg,falling into ASA physical statusⅠ-Ⅲ,were randomly divided into two groups with group M(modified rapid sequence induction)and group R(traditional rapid sequence induction).After sufficient preoxygenation,rapid sequence induction in supine position and cricoid cartilage compression were received in group R;rapid sequence induction in head-up position(20°-30°),and jaw thrust to open the airway during apnea time were performed in group M.No mechanical ventilation was used during induction.If SpO 2 was lower than 92%,manual assisted ventilation with small tidal volume was used to maintain oxygenation.The exposure time of laryngoscope,intubation time,non ventilation time,minimum SpO 2 and the time required for SpO 2 to decrease from 100%to 99%were recorded.The complications of cough,reflux,aspiration and aspiration pneumonia were recorded.Results Compared with group R,the time required for SpO 2 to decrease from 100%to 99%was longer than that in group M(P<0.05),and the minimum SpO 2 in group M was significantly higher than that in group R(P<0.01).There was no significant difference in cough,reflux,aspiration,aspiration pneumonia and other complications between the two groups.Conclusion Modified rapid sequence induction and intubation with head-up position(20°-30°)combined with jaw thrust during apnea time can not only effectively prevent reflux and aspiration,but also maintain high SpO 2 and prolong the safe time during apnea time.

关 键 词：托下颌 无通气安全时间 头高位 快顺序诱导插管 

分 类 号：R614[医药卫生—麻醉学]