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盲探气管插管装置经口插管在鼻部整形困难气道患者中的应用
Application of orotracheal intubation using blind tracheal intubation device for patients received operation on nose with difficult airway

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DOI:
作者:
严佳，姜虹，朱也森
YAN Jia, JIANG Hong, ZHU Ye-seng
作者单位:
上海交通大学医学院附属第九人民医院麻醉科
Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
关键词:
清醒气管插管；盲探气管插管装置；纤维光导支气管镜；经口气管插管
Awake intubation; Blind tracheal intubation device; Fibreoptic bronchoscope; Orotracheal intubation
摘要:
【摘要】 目的 通过比较盲探气管插管装置与纤维光导支气管镜引导经口清醒气管插管的应用效果，来验证盲探气管插管装置经口插管在鼻部整形困难气道患者中的临床应用价值。方法 60例接受鼻部整形的困难气道患者，平均分为2组(n=30)，组I采用盲探气管插管装置经口气管插管，组II采用纤维光导支气管镜引导经口气管插管。观察两组的气管插管成功率、插管所用时间、循环和呼吸功能变化及并发症情况。结果 组I插管成功率为100%(30/30)；组II插管成功率为93.3%(28/30)，2例失败患者是由于张口度过小仅能通过气管导管而无法置入保护牙垫，为防止纤维光导支气管镜镜干因患者在插管过程中不自主咬合而损坏，改为使用盲探气管插管装置经口插管成功。组I平均插管时间为4.1±1.3min，组II平均插管时间为3.8±1.2min，2组在插管时间上差异无统计学意义(P>0.05)。气管插管过程中2组患者心率(HR)均加快、平均动脉压(MAP)均升高，2组HR和MAP最大值与基础值比较，差异有显著统计学意义(P<0.05) ,2组HR和MAP的最大上升幅度差异无统计学意义(P>0.05)。结论 盲探气管插管装置与纤维光导支气管镜引导经口气管插管都具有成功率高、操作简便、并发症少的特点。盲探气管插管装置还可用于一些纤维光导支气管镜难以解决的困难气道插管并且成本较低，可用于接受鼻部整形的困难气道患者的经口气管插管，具有临床推广应用价值。
【Abstract】 Objective Comparing the application of the blind intubation device with fibreoptic bronchoscope for awake orotracheal intubation,to prove the application value of the blind intubation device in patients received plastic sugery on nose with difficult airway. Methods Sixty patients who received plastic sugery on nose with difficult airway were divided into two groups(n=30). Group I received awake orotracheal intubation with the blind intubation device.Group II received fibreoptic bronchoscope for awake orotracheal intubation.The success rate, time consuming of intubation,the changes of circulation and respiration and complications were evaluated. Results The success rate of group I was 100%(30/30),and that of group II was 93.3%(28/30).The reason for the two unsuccessful cases was that the size of the oral opening was too small to place the protective bite-block which can prevent the stem of bronchoscope from being damaged,and just the tracheal catheter could pass through the mouth.The two cases received the blind intubation device technique successfully at last. The mean time consuming of group I was 4.1±1.3min,while that of group II was 3.8±1.2min,and the difference of two groups has no statistical significance (P>0.05).In the course of intubation,the heart rate(HR) and mean arterial pressure(MAP) increased in both groups.Comparing with the basic values,the maximal HR and MAP during intubation increased obviously in both groups(P<0.05).The difference of the maximal range of increase of HR and MAP in the two groups has no statistical significance(P>0.05).Conclusion Used for orotracheal intubation,both fibreoptic bronchoscope technique and blind intubation device have the characteristics of high success rate，easy to use and few complication. The blind intubation device can be used for some conditions which can not be resolved by fibreoptic bronchoscope.Furthermore,the blind intubation device has the advantage of low cost.So the blind intubation device can be used for orotracheal intubation in patients received plastic sugery on nose with difficult airway,and has the value of clinical popularization and application.

 

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