阻塞性睡眠呼吸暂停综合征患者不同纤维支气管镜插管方法的临床效果观察  

Clinical effect of different fiberoptic bronchoscopy intubation methods in patients with obstructive sleep apnea syndrome

作　　者：张丽伟[1] 董文泽 贾倩倩[1] 杨晓春[1] 孙海军[1] 刘莉[1] Zhang Liwei;Dong Wenze;Jia Qianqian;Yang Xiaochun;Sun Haijun;Liu Li(Department of Anesthesiology, the First Hospital of Qinhuangdao City, Hebei Province, Qinhuangdao 066000,China)

机构地区：[1]河北省秦皇岛市第一医院麻醉科,066000

出　　处：《疑难病杂志》2020年第9期931-935,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：秦皇岛市科技计划资助项目(201805A035)。

摘　　要：目的观察利多卡因雾化吸入表面麻醉联合舒芬太尼、右美托咪啶清醒镇静下行纤支镜插管在阻塞性睡眠呼吸暂停综合征患者困难插管中的临床效果。方法选择2018年12月—2019年11月于河北省秦皇岛市第一医院经多导睡眠监测仪确诊为阻塞性睡眠呼吸暂停综合征,拟行手术治疗的患者60例,随机数字表法分为2组,各30例。观察组采用利多卡因雾化吸入法表麻联合舒芬太尼、右美托咪啶清醒镇静状态下行纤支镜插管;对照组采用达克罗宁胶浆含漱并涂抹气管导管下端,联合舒芬太尼、右美托咪啶清醒镇静状态下行纤支镜插管。记录入室后5分钟(T0)、插管前(T1)、插管后1 min(T2)及5 min(T3),拔除气管插管前(T4)、后5 min(T5)的SBP、DBP、HR、SPO2。分别于T0、T2、T4时,抽取动脉血测定pH、PaO2、PaCO2。记录插管时间、一次插管成功率及有无呛咳、喉痉挛的发生。结果观察组SBP、DBP、HR于T2时与对照组比较均明显下降(P<0.05),观察组SBP、DBP、HR于T4时与对照组比较均明显升高(P<0.05)。观察组SpO2在T1时明显高于对照组(P<0.05)。观察组于T0、T2时PaO2明显高于对照组,差异有统计学意义(P<0.05)。观察组插管时间明显短于对照组(P<0.01);观察组的呛咳反应发生率)明显低于对照组(6.6%vs.16.7%,P<0.05)。结论利多卡因雾化吸入表面麻醉联合舒芬太尼、右美托咪啶镇静用于阻塞性睡眠呼吸暂停综合征患者纤支镜插管时间短,供氧充分,能够减轻插管时患者的心血管反应。Objective To observe the clinical effect of lidocaine aerosol inhalation combined with sufentanil and dexmedetomidine in difficult intubation of patients with obstructive sleep apnea syndrome in ENT department.Methods From December 2018 to November 2019,60 patients with obstructive sleep apnea syndrome diagnosed by polysomnography in Department of Otorhinolaryngology,Qinhuangdao first hospital,Hebei Province were selected and randomly divided into two groups.The observation group was given lidocaine atomization inhalation combined with sufentanil and dexmedetomidine under conscious sedation,while the control group was given dacronine mucilage gargling and smearing the lower end of the endotracheal tube,combined with sufentanil and dexmedetomidine under conscious sedation.SBP,DBP,HR and SpO2 were recorded at 5 minutes(T0),before intubation(T1),1 minute(T2)and 5 minutes(T3)after tracheal intubation,and before extubation(T4)and 5 minutes after tracheal intubation(T5).At T0,T2 and T4,arterial blood was drawn to determine pH,PaO2 and PaCO2.The intubation time,the success rate of intubation and the occurrence of choking and laryngospasm were recorded.Methods Compared with control group,SBP,DBP,HR in the observation group was significantly lower at T2(P<0.05),while those parameters washigher at T4(P<0.05).SpO2 in the observation group was significantly higher than that in the control group at T1(P<0.05).PaO2 in the observation group was significantly higher than that in the control group at T0 and T2(P<0.05).The intubation time of the observation group was significantly shorter than that of the control group(P<0.01);the incidence of cough reaction in the observation group was significantly lower than that in the control group(6.6%vs.16.7%,P<0.05).Conclusion Lidocaine aerosol inhalation combined with sufentanil and dexmedetomidine for sedation in patients with obstructive sleep apnea syndrome has short intubation time and sufficient oxygen supply,which can reduce the cardiovascular response of patients during intubation.

关 键 词：纤维支气管镜 气管插管 阻塞性睡眠呼吸暂停 困难插管 

分 类 号：R61[医药卫生—外科学]