魏氏鼻咽通气道联合可视软性喉镜经鼻气管插管在困难气道患儿中的应用  

Application of Wei's nasopharynx airway combined with electrically-operated flexible scope for transnasal tracheal intuba-tion in children with difficult airways

作　　者：许福生 颜景佳 魏媛媛 林建水[1] 刘小红 卢清旺 Xu Fusheng;Yan Jingjia;Wei Yuanyuan;Lin Jianshui;Liu Xiaohong;Lu Qingwang(Department of Anesthesiology,Jinjiang Municipal Hospital(Shanghai Sixth People's Hospital Fujian Campus),Jinjiang 362200,China)

机构地区：[1]晋江市医院(上海市第六人民医院福建医院)麻醉科,晋江362200

出　　处：《国际麻醉学与复苏杂志》2024年第8期835-839,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探索魏氏鼻咽通气道联合电子软镜经鼻气管插管在困难气道患儿中应用的可行性及安全性。方法选择2021年7月—2023年7月在晋江市医院经气管插管静脉吸入复合全麻下行手术治疗的困难气道患儿40例,8~12岁,按随机数字表法分为魏氏鼻咽通气道联合电子软镜插管组(W组)和直接电子软镜气管插管组(D组),每组20例。两组患儿在气道开放前均未给予肌松剂。W组采用8%七氟醚+8 L/min氧流量面罩吸入+2μg/kg瑞芬太尼静脉注射进行麻醉诱导,待患儿脑电双频指数(BIS)<60时经一侧鼻腔插入魏氏鼻咽通气道且由一位麻醉助手经鼻咽通气道行手控常频声门上喷射通气,麻醉医师经另一侧鼻腔采用电子软镜进行气管插管;D组采用8%七氟醚+8 L/min氧流量面罩吸入进行麻醉诱导,待患儿BIS<75时经一侧鼻腔采用电子软镜插管,当脉搏血氧饱和度(SpO_(2))下降到90%时拔出电子软镜,面罩加压给氧,待SpO_(2)回升到99%以上时再次插管。记录两组患儿插管前(T_(0))、插管成功即刻(T_(1))的平均动脉压(MAP)、心率,最低SpO_(2),插管次数,一次插管成功率,插管总耗时,插管时BIS,术后并发症发生情况。结果W组插管时BIS、插管次数、插管总耗时均小于D组(均P<0.05),一次插管成功率高于D组(P<0.05)。T_(1)时W组MAP、心率均低于D组(均P<0.05),最低SpO_(2)高于D组(P<0.05)。两组患儿术后并发症发生率差异无统计学意义(均P>0.05)。结论与直接电子软镜气管插管相比,魏氏鼻咽通气道联合电子软镜经鼻气管插管在困难气道患儿中血流动力学波动较小,患儿最低SpO_(2)、一次插管成功率均更高,插管总耗时更短,且不增加术后并发症,但需要一位麻醉助手参与。Objective To explore the feasibility and safety of the application of Wei's nasopharyngeal airway combined with electrically-operated flexible scope for transnasal tracheal intubation in children with difficult airways.Methods A total of 40 chil-dren with difficult airway,aged 8‒12 years,who underwent surgery who underwent surgery under general anesthesia with tracheal intu-bation in Jinjiang Hospital from July 2021 to July 2023 were selected.According to the random number table method,they were divid-ed into two groups(n=20):a Wei's nasopharynx airway combined with electrically-operated flexible scope group(group W)and a direct tracheal intubation with electrically-operated flexible scope group(group D).No muscle relaxants were administered before airway opening.In group W,anesthesia was induced by 8%sevoflurane+8 L/min oxygen flow by mask inhalation+2μg/kg remifentanil by in-travenous injection.When the children's bispectral index(BIS)was<60,the Wei's nasopharyngeal airway was inserted into one side of the nasal cavity and an anesthesia assistant performed hand-controlled constant-frequency supra-glottal jet ventilation through the naso-pharyngeal airway,while anesthesia physicians used an electrically-operated flexible scope to intubate through the other side of the na-sal cavity.In group D,anesthesia was induced by 8%sevoflurane+8 L/min oxygen flow by mask inhalation.When the children's BIS was<75,they were intubated through one side of the nasal cavity with an electrically-operated flexible scope,and the scope was with-drawn when the pulse oximetry saturation(SpO_(2))dropped to 90%,and oxygen was administered under pressure by mask.Then they were intubated again when the SpO_(2)rebounded to more than 99%.Then,mean arterial pressure(MAP),heart rate,minimum SpO_(2),the number of intubation,the success rate of one-time intubation,total time to intubation,BIS value at intubation,and the incidence of post-operative complications were recorded in the two groups before intubation(T_(0))and at the moment of succe

关 键 词：鼻咽通气道 电子软镜 儿童 困难气道 

分 类 号：R726.1[医药卫生—儿科]