标题:分体式可视喉镜联合纤维支气管镜气管插管在腭咽成形术中的应用
作者:刘宗玉,熊国强,姜贺,周宇航,匡珍 深圳市龙岗区耳鼻咽喉医院深圳市耳鼻咽喉研究所,广东 深圳 518172
卷次:
2019年30卷9期
【摘要】 目的 探讨腭咽成形术中应用分体式可视喉镜(珠海氧瞬得)联合纤维支气管镜(Ambu)进行气管插管的效果及可行性。方法 选择2017年2月至2018年1月在深圳市龙岗区耳鼻咽喉医院行腭咽成形术患者90例为研究对象,所有患者Mallampati气道分级为Ⅳ级,属于困难气道患者。采用随机数表法分为对照组和实验组,每组45例,患者取仰卧位,全静脉麻醉诱导,诱导麻醉药为依托咪酯0.3 mg/kg、舒芬太尼0.5 μg/kg、维库溴铵0.1 mg/kg,诱导后用丙泊酚TCI模式2.8 μg/mL、瑞芬太尼0.3 μg/(kg·min)维持,对照组使用分体式可视喉镜经口气管插管,实验组使用分体式可视喉镜联合纤维支气管镜经口气管插管,比较两组患者的插管次数、插管时间、有无损伤,以及插管前后患者心率和血压变化情况。结果 两组患者插管前后的平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2)比较,差异均无统计学意义(P>0.05);实验组患者的插管时间为(26.93±5.68) s,明显短于对照组的(131.14±14.47) s,并且一次插管成功率为95.56%,明显高于对照组的77.78%,差异均有统计学意义(P<0.05);实验组患者插管后损伤率为8.89%,明显低于对照组的37.78%,差异有统计学意义(P<0.05 )。结论 分体式可视喉镜联合纤维支气管镜对于腭咽成形术的气管插管是一种可行有效的方法,能解决腭咽成形术困难气道插管问题。
【关键词】 阻塞性睡眠呼吸暂停低通气综合征;分体式可视喉镜;纤维支气管镜;气管插管;腭咽成形术
【中图分类号】 R767.91 【文献标识码】 A 【文章编号】 1003—6350(2019)09—1179—03
Application of separate visual laryngoscope combined with fiberoptic bronchoscope for tracheal intubation inpalatopharyngoplasty.
LIU Zong-yu, XIONG Guo-qiang, JIANG He, ZHOU Yu-hang, KUANG Zhen. ShenzhenLonggang ENT Hospital, Shenzhen 518172, Guangdong, CHINA
【Abstract】 Objective To investigate the effect and feasibility of tracheal intubation with separate visual laryn-goscope (Zhuhai Airtraq) combined with fiberoptic bronchoscope (Ambu) in palatopharyngoplasty. Methods FromFebruary 2017 to August 2018, 90 patients in Shenzhen Longgang ENT Hospital (Mallampati airway gradeⅣ) were random-ly divided into an observation group and a control group, with 45 patients in each group. The patients were in supine positionand induced by total intravenous anesthesia with etomidate 0.3 mg/kg, sufentanil 0.5 μg/kg, and vecuronium 0.1 mg/kgand then maintained with propofol TCI mode of 2.8 μg/mL and remifentanil 0.3 μg/(kg·min). When endotracheal intuba-tion conditions were satisfied, endotracheal intubation was performed with separate visual laryngoscope in the controlgroup, and separate visual laryngoscope combined with fiberoptic bronchoscope in the observation group. The times ofintubation, intubation time, injury, heart rate, and blood pressure were compared and analyzed between the two groups.Results There was no significant difference in mean arterial pressure (MAP), heart rate (HR), and pulse oxygen satura-tion (SpO2) after intubation between the two groups (P>0.05). The intubation time in the observation group was (26.93±5.68) s, significantly shorter than (131.14±14.47) s in the control group (P<0.05), and the success rate of one intubationwas 95.56%, significantly higher than 77.78% in the control group (P<0.05). The rate of injury after intubation in the obser-vation group was 8.89%, significantly lower than 37.78% in the control group (P<0.05). Conclusion Separate visual la-ryngoscope combined with fiberoptic bronchoscope is feasible and effective for tracheal intubation in palatopharyngo-plasty, which can help solve difficult airway problems.
【Key words】 Obstructive sleep apnea-hypopnea syndrome; Separate visual laryngoscope; Fiberoptic broncho-scope; Tracheal intubation; Palatopharyngoplasty·短篇论著·doi:10.3969/j.issn.1003-6350.2019.09.028基金项目:广东省深圳市龙岗区科技发展资金医疗卫生(扶持类)项目(编号:2017040117485976)
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