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0.5μg/kg、维库溴铵0.1 mg/kg,诱导后用丙泊酚TCI模式2.8μg/mL、瑞芬太尼0.3μg/(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。
Objective To investigate the effect and feasibility of tracheal intubation with separate visual laryngoscope(Zhuhai Airtraq) combined with fiberoptic bronchoscope(Ambu) in palatopharyngoplasty. Methods From February 2017 to August 2018, 90 patients in Shenzhen Longgang ENT Hospital(Mallampati airway grade Ⅳ) were randomly divided into an observation group and a control group, with 45 patients in each group. The patients were in supine position and induced by total intravenous anesthesia with etomidate 0.3 mg/kg, sufentanil 0.5 μg/kg, and vecuronium 0.1 mg/kg and then maintained with propofol TCI mode of 2.8 μg/m L and remifentanil 0.3 μg/(kg·min). When endotracheal intubation conditions were satisfied, endotracheal intubation was performed with separate visual laryngoscope in the control group, and separate visual laryngoscope combined with fiberoptic bronchoscope in the observation group. The times of intubation, 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 saturation(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 intubation was 95.56%, significantly higher than 77.78% in the control group(P<0.05). The rate of injury after intubation in the observation group was 8.89%, significantly lower than 37.78% in the control group(P<0.05). Conclusion Separate visual laryngoscope combined with fiberoptic bronchoscope is feasible and effective for tracheal intubation in palatopharyngoplasty, which can help solve difficult airway problems.
引文
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