经鼻气管插管全身麻醉在成人扁桃体切除术中的应用  

The application of nasotracheal intubation general anesthesia for the operation of adult tonsillectomy

作　　者：米智华 高巨[1,2] 黄天丰[1,2] 

机构地区：[1]扬州大学临床医学院 [2]江苏省苏北人民医院麻醉科,扬州225000

出　　处：《南通大学学报（医学版）》2015年第5期387-389,共3页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(81171838);江苏省医学重点人才资助项目(RC2011041)

摘　　要：目的 :探讨经鼻气管插管在成人扁桃体切除术中的麻醉效果、安全性及可行性。方法 :选择ASAⅠ~Ⅱ级拟在全身麻醉下行扁桃体切除术的患者40例,随机分为经口插管组(O组)及经鼻插管组(N组)。分别监测两组患者麻醉前、麻醉诱导后(气管插管前)、置入支撑喉镜时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏氧饱和度(pulse oxygen saturation,Sp O2)的变化,记录气管插管时间,术中气管受压情况,手术操作时间,术中出血量及术后并发症。结果:两组患者均成功完成手术,在置入支撑喉镜时MAP均有不同程度升高、HR增快(P<0.05),但两组间比较差异无统计学意义(P>0.05);气管插管时间N组明显长于O组(P<0.05);O组术中有3例患者因开口器压迫气管导管需暂停手术、重新调整导管位置;手术时间N组明显短于O组(P<0.05),术中出血量N组明显少于O组(P<0.05),两组Sp O2差异无统计学意义(P>0.05),术后均未发现出血病例。结论:经鼻气管插管虽然插管时间较经口气管插管长,但是口腔暴露更充分,气管导管不易受压,手术医师操作空间更大,术中止血彻底,手术时间明显缩短,可安全应用于成人扁桃体切除术。Objective: To evaluate the anesthesia effects, safety and the feasibility of tonsillectomy under nasotracheal intubation general anesthesia. Methods: Forty patients(ASA grade Ⅰ~Ⅱ) undergoing elective tonsillectomy were selected and randomly divided into group O ( oral intubation group ) and group N ( nasal intubation group ) . The indexes were monitored respectively as follow: mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(SpO2) value changes before intubation, anesthesia intubation, when placing the laryngoscope. Recording the intubation time, the situation of tracheal press during the operation, operation time, amount bleeding and postoperative complication. Results: Two groups of patients were successfully completed surgery. When placing the laryngoscope , there were varying degrees of increase in MAP and HR, the differences were statistically significant. But there was no statistically significant difference between two groups. The time of nasotracheal intubation was longer than orotracheal intubation(P<0.05), there were three patients must suspend operation and adjust the location of endotracheal tube again due to the press of mouth gag in group O. The operation time in group N was significantly shorter than that in group O(P<0.05), the amount of bleeding during in operation group N was significantly less than that in group O(P<0.05). There was no statistically significant difference in the two groups of SpO 2, All the cases had not be found bleeding after operation. Conclusion: Although the intubation time of nasotracheal intubation was longer than orotracheal, the mouth was exposed more fully, the endotracheal tube was not easy to be pressed, the operating space for surgery doctor was larger, the hemostasis of intraoperative was completely, and the operation time was significantly shortened, so it can be safely applied to adult tonsillectomy.

关 键 词：经鼻气管插管 经口气管插管 成人扁桃体切除术 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]