改良口咽通气道辅助可视插管软镜在困难气管插管中的应用效果及插管失败的影响因素  

Application effect of improved oropharyngeal airway assisted video flexible intubating scope in difficult endotracheal intubation and influence factors of intubation failure

作　　者：胡立群 李利 沙德利 肖宇 操石磊 吴惠民 王唐堃 HU Li-qun;LI Li;SHA De-li;XIAO Yu;CAO Shi-lei;WU Hui-min;WANG Tang-kun(Department of Anesthesiology,Tongling Municipal Hospital of Anhui Province/Tongling Hospital Affiliated to Wannan Medical College,Tongling Anhui 244000,China)

机构地区：[1]安徽省铜陵市立医院/皖南医学院附属铜陵医院麻醉科,安徽铜陵244000

出　　处：《局解手术学杂志》2022年第11期976-980,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：皖南医学院教学医院科研专项(自然科学类)(JXYY202118)。

摘　　要：目的探讨改良口咽通气道辅助可视插管软镜在困难气管插管中的应用效果并分析插管失败的影响因素。方法选择于我院通过改良口咽通气道辅助可视插管软镜插管治疗的困难气管插管患者90例作为改良组,另选择同期通过单纯可视插管软镜插管治疗的困难气管插管患者90例作为传统组。记录2组患者插管各时点的血流动力学变化,比较2组患者一次插管成功率、首次暴露声门时间、完成气管插管时间、血氧饱和度(SpO_(2))低于90%患者比例和插管的不良反应等。通过单因素及多因素Logistics回归模型分析改良组患者插管失败的独立危险因素,并进行模型评价。结果2组患者的平均动脉压(MAP)和心率(HR)在插管前(T1)时点均明显降低,在插管即刻(T2)时点有所回升,在插管后3 min(T3)时点继续降低,插管后5 min(T4)时点2组的HR持续降低,MAP有所回升。改良组患者首次暴露声门时间及完成气管插管时间均显著短于传统组(P<0.05),SpO_(2)低于90%患者比例及不良反应发生率均显著低于传统组(P<0.05),一次插管成功率显著高于传统组(P<0.05)。舌甲距离<2指是改良组患者插管失败的独立危险因素(P<0.05)。模型的一致性指数(C-index)为0.820(95%CI:0.747~0.893),校正曲线与理想曲线拟合度良好,受试者工作特征曲线下面积为0.820(95%CI:0.738~0.884),显示模型具有良好的预测精准度。结论通过改良口咽通气道辅助可提高可视插管软镜气管插管的成功率,还可减少不良反应的发生,值得临床推广。舌甲距离<2指是改良口咽通气道辅助可视插管软镜插管失败的独立危险因素,可通过该指标评估气管插管难易程度,在临床治疗中应对舌甲距离<2指的患者特别关注。Objective To explore the application effect of improved oropharyngeal airway assisted video flexible intubating scope in difficult endotracheal intubation,and analyze the influencing factors of intubation failure.Methods Ninety patients with difficult endotracheal intubation who received endotracheal intubation with improved oropharyngeal airway assisted video flexible intubating scope in our hospital were selected as the improved group,and 90 patients with difficult endotracheal intubation who received endotracheal intubation with video flexible intubating scope during the same period were selected as the traditional group.The hemodynamic changes at each time point of intubation were compared between the two groups.The successful rate of one-time intubation,the time to first glottis exposure,the endotracheal intubation time,the proportion of patients with oxygen saturation(SpO_(2))below 90%and the adverse reactions of intubation of the two groups were compared.Univariate and multivariate Logistics regression models were used to analyze the independent risk factors of intubation failure in the improved group,and the model was evaluated.Results The mean arterial pressure(MAP)and heart rate(HR)of the two groups were significantly decreased before intubation(T1),increased immediately after intubation(T2),and continued to decrease at 3 minutes after intubation(T3).At 5 minutes after intubation(T4),the HR of the two groups continued to decrease and MAP increased.The time to first glottis exposure and the endotracheal intubation time in the improved group were significantly shorter than those in the traditional group(P<0.05),the proportion of patients with SpO_(2) below 90%and the incidence of adverse reactions were significantly lower than those in the traditional group(P<0.05),the successful rate of one-time intubation was significantly higher than that in the traditional group(P<0.05).The distance from lingual artery to superior thyroid artery<2 fingers wide was the independent risk factor for intubation failure in

关 键 词：困难气管插管 可视插管软镜 改良口咽通气道 应用效果 

分 类 号：R322.3[医药卫生—人体解剖和组织胚胎学]