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2011年第4期
快速序贯诱导下纤支镜经口和经鼻气管插管的对比研究
A Comparison of Oral and Nasal Tracheal Intubation with the Aid of Fiberoptic Bronchoscope undergoing Rapid Sequence Induction
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DOI:
作者:
汪辉德,钟庆△, 伍保均,肖其珍,邬瑞刚,陈涛,杨国仁
WANG Hui-de, ZHONG Qing△, WU Bao-jun, et al.
作者单位:
四川省简阳市人民医院麻醉科(汪辉德﹑钟庆﹑邬瑞刚﹑陈涛﹑杨国仁),耳鼻喉科(伍保均﹑肖其珍)
Department of Anesthesiology, Jianyang people's Hospital, Jianyang, Sichuan 641400, China
关键词:
快速序贯诱导;纤维支气管镜;经口气管插管;经鼻气管插管
Rapid sequence induction; Fiberoptic bronchoscope; Oral tracheal intubation; Nasal tracheal intubation
摘要:
目的 在快速序贯诱导(rapid sequence induction, RSI)下,比较纤支镜经口和进鼻两种路径的插管时间等临床指标。 方法 选取ASAI-II级,年龄18-65岁的择期声带息肉及小结摘除术全麻患者60例,随机分成两组(n=30)行纤支镜气管插管:O组选择经口路径,N组用经鼻路径。麻醉诱导采用RSI,待病人意识丧失肌肉松弛后行纤支镜操作。观察并记录两组患者声门暴露时间,气管插管时间及总成功率,调整托下颌次数和出现颈前区红点的例数,以及插管相关并发症。 结果 两组患者均获成功,操作期间未见明显并发症,无退出病例。声门暴露N组快于O组( P < 0. 05),而插管时间两组无差异( P > 0. 05)。调整托下颌例数N组明显少于O组( P < 0. 05),而出现颈前区红点例数则明显多于O组( P < 0. 05) 结论 快速序贯诱导下纤支镜经口和经鼻两种路径皆可获满意安全的临床效果;经鼻路径可更快速的暴露声门,原因可能与解剖路径较接近中线和需要他人配合操作减少有关。
Objective To compare oral and nasal tracheal intubation with the aid of fiberoptic bronchoscope undergoing rapid sequence induction. Methods Sixty ASA I-II patients,aged 18-65 yr, who scheduled for excision of vocal cord nodules and polyps requiring general anesthesia were randomly assigned to two group (n=30,each): O group choosing fiberoptic bronchoscope guided oral tracheal intubation and N group using fiberoptic bronchoscope for nasal tracheal intubation. After rapid sequence induction,insertion of endotracheal tube was performed. The time of glottic exposure and trachea intubation, success rate, cases of adjusting elevation of jaw and red dot appeared in cervical area, and incidence of complications were recorded. Results All cases were successful and no cases were withdrawal. The time of glottic exposure was faster in N group than O group ( P < 0. 05), but there was no obvious statistical significance in the time of trachea intubation ( P>0. 05). The cases of adjusting elevation of jaw in N group were less than O group, but cases of red dot appeared in cervical area were more than O group ( P < 0. 05). Conclusions Oral and nasal tracheal intubation with the aid of fiberoptic bronchoscope undergoing rapid sequence induction can be both safely and satisfactory clinical use; nasal path can be a faster time of the glottic exposure, probably with the anatomy of the path closer to the middle line and the needs of others’ help decreased.