纤维支气管镜引导对经鼻腔气管插管患者术后拔管时鼻出血的影响  

Effect of fiberoptic bronchoscope guided nasotracheal intubation on epistaxis after trachea extubation

作　　者：曹爽[1] 康华[1] 陈洁[1] CAO Shuang;KANG Hua;CHEN Jie(Department of Anaesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 20001l,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《中国口腔颌面外科杂志》2023年第3期253-257,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:探讨使用纤维支气管镜对经鼻腔气管插管(nasotracheal intubation,NTI)患者术后拔管时鼻出血的发生率及其严重程度的影响。方法:回顾分析2021年10月—2022年10月接受全身麻醉且术后于麻醉苏醒室拔管的NTI患者资料,根据插管方法不同分为纤维支气管镜引导组(纤支镜组)和盲插鼻腔、使用可视喉镜组(可视喉镜组)。采用倾向性评分匹配(propensity score matching,PSM)均衡2组基线资料后,比较2组患者术后拔管时鼻出血的发生率和严重程度。采用SPSS 26.0软件包对数据进行统计学分析。结果:共纳入557例患者,PSM成功匹配103对患者。PSM后2组基线数据无统计学差异。纤支镜组的鼻出血发生率(18.4%)显著低于可视喉镜组(38.8%)[相对危险度(RR)为0.475;95%CI:0.296~0.762;P<0.001],纤支镜组鼻出血的严重程度也更低(Wilcoxon Mann-Whitney odds比值为0.644;95%CI:0.490~0.832;P=0.001)。结论:与可视喉镜相比,纤维支气管镜引导的NTI降低了术后拔管时鼻出血的发生率和严重程度。PURPOSE:To explore the influence of fiberbronchoscopic guidance on the incidence and severity of epistaxis during extubation among patients with nasotracheal intubation(NTI).METHODS:This retrospective analysis was conducted among patients who received general anesthesia with NTI and extubated in the postanesthesia care unit between October 2021 to October 2022.According to different intubation approach,the patients were divided into fiberoptic bronchoscope guided group(fiberoptic group),blind insertion and video laryngoscope group(video laryngoscope group).The propensity score matched analysis(PSM)was used to equalize the baseline data of the two groups,and then the incidence and severity of epistaxis during extubation were compared between the two groups.SPSS 26.0 software package was used for data analysis.RESULTS:There was no significant difference in baseline data between the two groups after PSM(P>0.05).The incidence of epistaxis was higher in the video laryngoscope group(38.8%)than in the fiberoptic group(18.4%;relative risk,0.475;95%Cl:0.296-0.762;P<0.001).The severity of bleeding was also lower in the video laryngoscope group(Wilcoxon Mann-Whitney odds,0.644;95%CI:0.490-0.832,P=0.001).CONCLUSIONS:Fiberoptic bronchoscope guided NTI reduced the incidence and severity of epistaxis during extubation when compared with NTI performed via blind insertion and video laryngoscope.

关 键 词：经鼻腔气管插管 纤维支气管镜 鼻出血 

分 类 号：R782.05[医药卫生—口腔医学]