自塑形导管经鼻气管插管在婴儿颅缝早闭手术中的应用  

Application of self-shaped tube in nasotracheal intubation in infants with craniosynostosis

作　　者：王建设[1] 占文强 刘娇 安宏嫱 费建[1] 赵龙德[1] WANG Jianshe;ZHAN Wenqiang;LIU Jiao;AN Hongqiang;FEI Jian;ZHAO Longde(Department of Anesthesiology,Children s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院麻醉科,210008

出　　处：《临床麻醉学杂志》2021年第4期348-351,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察自塑形导管经鼻气管插管在婴儿颅缝早闭手术中的应用效果。方法择期全麻下行颅缝早闭手术患儿100例,男58例,女42例,年龄1~12个月,ASAⅠ或Ⅱ级,随机分为两组:自塑形导管插管组(S组)和插管钳辅助插管组(F组)。静脉诱导后均在可视喉镜下使用加强型导管行经鼻气管插管,S组导管经柔软管芯塑形成特殊形状,调整导管方向置入气管,F组经插管钳引导置入气管。记录喉部暴露Cormark-Lehane分级、首次插管成功率、插管总成功率、插管时间,记录诱导后(T_(1))、声门暴露时(T_(2))、插管后1 min(T_(3))、插管后3 min(T_(4))的HR、MAP、SpO_(2)和插管时并发症发生情况;记录术后拔管时间及拔管后并发症的情况。结果与F组比较,S组首次插管成功率明显升高,插管时间明显缩短,咽部软组织损伤和拔管后声音嘶哑发生率明显降低(P<0.05),T_(3)时S组HR明显更慢,MAP明显更低(P<0.05)。与T_(1)时比较,T_(3)时两组患儿HR明显增快,MAP明显升高(P<0.05)。两组喉镜暴露分级、拔管时间、拔管后二次插管率和SpO_(2)差异无统计学意义。结论自塑形导管经鼻气管插管可安全用于1岁以内婴儿颅缝早闭手术的气道管理,效果优于插管钳辅助下经鼻插管。Objective To evaluate the efficacy of self-shaped tube in nasotracheal intubation in infants with craniosynostosis under video laryngoscope.Methods One-hundred infants with craniosynostosis,58 males and 42 females,aged 1-12 months,falling into ASA physical statusⅠorⅡscheduled for elective craniofacial reconstruction surgery under nasotracheal intubation,were randomly divided into two groups:self-shaped tube group(group S)and intubation forceps group(group F).Nasotracheal intubation with reinforced tube was performed in both groups after intravenous induction.In group S,the tube was formed into special shape by soft stylet,and adjusted the direction into the trachea,while the tube in group F was inserted into the trachea guided by forceps.The success rate of intubation,intubation time were recorded.HR,MAP,and SpO_(2)after anesthesia induction(T_(1)),glottis exposure(T_(2)),1 minute after intubation(T_(3)),and 3 minutes after intubation(T_(4))were recorded.and the incidences of complications during intubation were recorded,and the time of extubation and incidence of complications after extubation were also recorded.Results Compared with group F,the success rate of the first intubation was significantly higher in group S,the intubation time was significantly shorter,and the incidence of pharyngeal soft tissue injury and hoarseness after extubation was significantly lower(P<0.05),the HR and MAP were significantly lower at T_(3)in group S(P<0.05).Compared with T_(1),HR and MAP were significantly increased in both groups at T_(3)(P<0.5).There were no significant differences in laryngoscopy exposure grade,extubation time,secondary intubation rate and SpO_(2)between the two groups.Conclusion Nasotracheal intubation with self-shaped tube can be safely used for airway management in infants with craniosynostosis under 1 year-old,and the effect is better than that with intubation forceps.

关 键 词：自塑形导管 经鼻插管 颅缝早闭 婴儿 并发症 

分 类 号：R726.1[医药卫生—儿科]