光索辅助经鼻气管插管应用于神经重症患者的优劣分析  

Analysis of nasotracheal intubation assisted by flexible lightwand in patients with severe neurological disease

作　　者：杨林 张晓青 向琰 秦逊 裴玉春 吕胜青 YANG Lin;ZHANG Xiao-qing;XIANG Yan;QIN Xun;PEI Yu-chun;Lü Sheng-qing(Department of Neurosurgery,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]中国人民解放军陆军军医大学第二附属医院神经外科,重庆400037

出　　处：《生物医学工程与临床》2022年第1期66-71,共6页Biomedical Engineering and Clinical Medicine

基　　金：中国人民解放军陆军军医大学临床医学科研人才培养计划资助项目(2018XLC3030)。

摘　　要：目的探讨光索辅助经鼻气管插管(FL-NTI)在神经重症患者中的应用效果,评估FL-NTI的有效性、安全性。方法选择2019年10月至2020年10月在陆军军医大学第二附属医院神经外科收治的需行经鼻气管插管的52例神经重症患者,其中男性29例,女性23例;年龄20~78岁,平均年龄47.94岁;体质量指数(BMI)16.11~29.45 kg/m^(2),平均BMI 24.59 kg/m^(2);高血压性脑出血(HICH)23例,自发性蛛网膜下腔出血(SAH)9例,脑外伤12例,颅内肿瘤8例;急性生理和慢性健康评分(APACH)Ⅱ平均值为(23.46±0.41)分;国际标准化比值(INR)平均值为1.38±0.06,部分凝血活酶时间(APTT)平均值为(37.02±0.86) s,血小板计数平均值为(202.40±8.03)×10^(9)/L。按照随机数表法分为FL-NTI组及经鼻盲探气管插管(B-NTI)组,每组26例。FL-NTI组采用FL-NTI,B-NTI组采用B-NTI。比较两组患者术中情况及术后并发症发生情况。结果 FL-NTI组首次插管成功率、总插管成功率、插管时间、插管过程中平均动脉压(MAP)与B-NTI组比较[73.08%vs 42.30%、92.31%vs 69.23%、(91.31±4.61) s vs (111.90±4.77) s、(108.90±1.25) mmHg vs (113.50±1.66) mmHg],差异有统计学意义(P <0.05)。FL-NTI组患者插管过程中心率(HR)、术后鼻腔大出血发生率与B-NTI组比较[(90.23±1.51)次/分vs (90.38±1.36)次/分、15.38%vs 7.69%],差异无统计学意义(P> 0.05)。结论 FL-NTI不增加术后鼻腔大出血发生率,具有插管成功率高、插管时间短、插管过程血流动力学平稳等优点,值得临床推广。Objective To analyze the effect of flexible lightwand-assisted nasotracheal intubation(FL-NTI) in patients with severe neurological disease, and assess effectiveness and safety of FL-NTI. Methods From October 2019 to October 2020,52 neurologically severe patients performed nasal endotracheal intubation were enrolled, which included 29 males and 23 females, aged 20-78 years old with mean age of 47.94 years old;body mass index(BMI) was 16.11-29.45 kg/m2 with mean BMI of 24.59 kg/m2;23 cases of hypertensive intracerebral hemorrhage(HICH), 9 of spontaneous subarachnoid hemorrhage(SAH),12 of brain trauma and 8 of intracranial tumor. The mean value of acute physiology and chronic health score(APACH) Ⅱ was(23.46 ± 0.41) scores;mean value of international normalized ratio(INR) was 1.38 ± 0.06, mean value of activated partial thromboplastin time(APTT) was(37.02 ± 0.86) seconds and mean value of platelet count was(202.40 ± 8.03) × 109/L. According to random number table method, all of them were divided into FL-NTI group(n = 26) and blind nasal tracheal intubation(B-NTI)group(n = 26). The intraoperative conditions and postoperative complications between 2 groups were compared. Results There were significant differences between FL-NTI group and B-NTI group in success rate of first endotracheal intubation(73.08 %vs 42.30 %), success rate of total endotracheal intubation(92.31 % vs 69.23 %), operation time[(91.31 ± 4.61) seconds vs(111.90 ± 4.77) seconds], and mean arterial pressure(MAP)[(108.90 ± 1.25) mmHg vs(113.50 ± 1.66) mmHg] during intubation(P < 0.05). There were no significant differences in heart rate(HR)[(90.23 ± 1.51) times/minutes vs(90.38 ± 1.36) times/minutes]and postoperative nasal hemorrhage rate(15.38 % vs 7.69 %) between 2 groups(P > 0.05). Conclusion It is demonstrated that FL-NTI has high clinical application value with advantages of high rate of successful intubation, short intubation time, slightly variation in hemodynamic parameters during intubation, and would not increase incidence of pos

关 键 词：光索辅助 经鼻气管插管 盲探气管插管 神经重症 

分 类 号：R614[医药卫生—麻醉学]