新型内镜鼻面罩在纤维支气管镜辅助气管插管中的临床应用
|
摘要
目的探讨新型内镜鼻面罩在纤维支气管镜辅助气管插管中的临床应用。方法选择60例拟行纤维支气管镜辅助气管插管的患者,随机分为对照组(n=30)和试验组(n=30):对照组采用鼻导管供氧右美托咪定联合低剂量丙泊酚静脉麻醉,试验组采用新型内镜鼻面罩供氧右美托咪定联合低剂量丙泊酚静脉麻醉。记录两组患者S_PO_2<90%发生率、插管时间及麻醉前(T_0)、麻醉后(T_1)、纤维支气管镜进入气道即刻(T_2)、气管导管送入即刻(T_3)、气管插管后5 min(T_4)各时间点的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),比较患者不良反应发生情况,评估患者麻醉效果评估。结果两组患者均顺利完成纤维支气管镜辅助气管插管。试验组S_PO_2<90%发生率明显低于对照组(P<0. 05);两组插管时间差异无统计学意义(P>0. 05)。与麻醉前(T_0)相比,两组MAP、HR在T_1时点降低(P<0. 05);组间比较,两组MAP、HR在各时点差异无统计学意义(P>0. 05);两组不良反应发生率差异无统计学意义(P>0. 05);两组麻醉效果均较好,差异无统计学意义(P>0. 05)。结论两组方法均能安全有效地用于纤维支气管镜辅助气管插管。新型内镜鼻面罩可有效防止静脉麻醉所引起的舌根后坠,保障呼吸道通畅,且供氧充分便捷,值得在纤维支气管镜辅助气管插管中推广应用。
Objective To evaluate the clinical application of a novel endoscopic nasal mask in fiberoptic bronchoscope-assisted intubation. Methods Sixty patients undergoing fiberoptic bronchoscope-assisted intubation during intravenous anesthesia with dexmedetomidine and low dose propofol were randomly assigned to nasal catheter oxygen supply group( control group,n = 30) and novel endoscopic nasal mask oxygen supply group( study group,n = 30). The primary outcomes including incidence of pulse oxygen saturation( S_PO_2) < 90%,intubation time; the secondary outcomes including mean arterial pressure( MAP),heart rate( HR) before anesthesia( T_0),after anesthesia( T_1),immediately after insertion of fiberoptic bronchoscope into the airway( T_2),immediately after insertion of tracheal catheter( T_3),5 minute after insertion of tracheal catheter( T_4) and the occurrence of adverse reactions and the anesthesia effect were compared between two groups. Results The incidence of pulse oxygen saturation( S_PO_2) <90% was significantly lower in study group than that in control group. There was no significant difference in intubation time between the two groups. MAP,HR in both groups decreased at T_1 as compared to those at T_0. There were no significant differences in the incidence of adverse reactions between two groups. The anesthetic efficacy was favorable in both groups. Conclusion In the intravenous anesthesia with dexmedetomidine and low dose propofol,oxygen supply via nasal catheter or the novel endoscopic nasal mask is safe and effective for fiberoptic bronchoscope-assisted intubation. The novel endoscopic nasal mask can effectively prevent tonguebase falling caused by intravenous anesthesia,protect airway patency to maintain sufficient oxygen supply.
Objective To evaluate the clinical application of a novel endoscopic nasal mask in fiberoptic bronchoscope-assisted intubation. Methods Sixty patients undergoing fiberoptic bronchoscope-assisted intubation during intravenous anesthesia with dexmedetomidine and low dose propofol were randomly assigned to nasal catheter oxygen supply group( control group,n = 30) and novel endoscopic nasal mask oxygen supply group( study group,n = 30). The primary outcomes including incidence of pulse oxygen saturation( S_PO_2) < 90%,intubation time; the secondary outcomes including mean arterial pressure( MAP),heart rate( HR) before anesthesia( T_0),after anesthesia( T_1),immediately after insertion of fiberoptic bronchoscope into the airway( T_2),immediately after insertion of tracheal catheter( T_3),5 minute after insertion of tracheal catheter( T_4) and the occurrence of adverse reactions and the anesthesia effect were compared between two groups. Results The incidence of pulse oxygen saturation( S_PO_2) <90% was significantly lower in study group than that in control group. There was no significant difference in intubation time between the two groups. MAP,HR in both groups decreased at T_1 as compared to those at T_0. There were no significant differences in the incidence of adverse reactions between two groups. The anesthetic efficacy was favorable in both groups. Conclusion In the intravenous anesthesia with dexmedetomidine and low dose propofol,oxygen supply via nasal catheter or the novel endoscopic nasal mask is safe and effective for fiberoptic bronchoscope-assisted intubation. The novel endoscopic nasal mask can effectively prevent tonguebase falling caused by intravenous anesthesia,protect airway patency to maintain sufficient oxygen supply.
引文
[1]COLLINS S R,BLANK R S.Fiberoptic intubation:an overview and update[J].Respir Care,2014,59(6)865-878;discussion 878-80.
[2]LI C W,LI Y D,TIAN H T,et al.Dexmedetomidinemidazolam versus sufentanil-midazolam for awake fiberoptic nasotracheal intubation:a randomized double-blind study[J].Chin Med J,2015,128(23):3143-3148.
[3]HU R,LIU J X,JIANG H.Dexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation:a double-blinded randomized controlled trial[J].J Anesth,2013,27(2):211-217.
[4]AMERICAN SOCIETY OF ANESTHESIOLOGISTSCOMMITTEE.Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration:application to healthy patients undergoing elective procedures:an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters[J].Anesthesiology,2011,114(3):495-511.
[5]纪淑敏,王清秀.右美托咪定减少术后恶心呕吐的研究进展[J].同济大学学报(医学版),2018,39(1):129-132.
[6]中华医学会麻醉学分会.2014版中国麻醉学指南与专家共识[M].北京:人民卫生出版社,2014.
[7]DA CONCEICAO M,FAVIER J C,BIDALLIER I,et al.Fiber-optic intubation with non-invasive ventilation with an endoscopic facial mask[J].Ann Fr Anesth Reanim,2002,21(4):256-262.
[8]BOURGAIN J L,BILLARD V,CROS A M.Pressure support ventilation during fibreoptic intubation under propofol anaesthesia[J].Br J Anaesth,2007,98(1):136-140.
[9]陈学信,周宏恩.全麻下25例无痛纤支镜检查临床体会[J].中国医疗前沿(上半月),2010,5(13):41-41.
[10]陈璞莹,苏向红,王桂兰,等.纤支镜无痛检查技术临床研究[J].中国药房,2010,21(10):907-909.
[11]戴体俊.麻醉药理学[M].北京:人民卫生出版社,2014.
[12]ARCANGELI A,D'ALOC,GASPARI R.Dexmedetomidine use in general anaesthesia[J].Curr Drug Targets,2009,10(8):687-695.
[13]KOROGLU A,TEKSAN H,SAGIR O,et al.A comparison of the sedative,hemodynamic,and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J].Anesth Analg,2006,103(1):63-67.
[2]LI C W,LI Y D,TIAN H T,et al.Dexmedetomidinemidazolam versus sufentanil-midazolam for awake fiberoptic nasotracheal intubation:a randomized double-blind study[J].Chin Med J,2015,128(23):3143-3148.
[3]HU R,LIU J X,JIANG H.Dexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation:a double-blinded randomized controlled trial[J].J Anesth,2013,27(2):211-217.
[4]AMERICAN SOCIETY OF ANESTHESIOLOGISTSCOMMITTEE.Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration:application to healthy patients undergoing elective procedures:an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters[J].Anesthesiology,2011,114(3):495-511.
[5]纪淑敏,王清秀.右美托咪定减少术后恶心呕吐的研究进展[J].同济大学学报(医学版),2018,39(1):129-132.
[6]中华医学会麻醉学分会.2014版中国麻醉学指南与专家共识[M].北京:人民卫生出版社,2014.
[7]DA CONCEICAO M,FAVIER J C,BIDALLIER I,et al.Fiber-optic intubation with non-invasive ventilation with an endoscopic facial mask[J].Ann Fr Anesth Reanim,2002,21(4):256-262.
[8]BOURGAIN J L,BILLARD V,CROS A M.Pressure support ventilation during fibreoptic intubation under propofol anaesthesia[J].Br J Anaesth,2007,98(1):136-140.
[9]陈学信,周宏恩.全麻下25例无痛纤支镜检查临床体会[J].中国医疗前沿(上半月),2010,5(13):41-41.
[10]陈璞莹,苏向红,王桂兰,等.纤支镜无痛检查技术临床研究[J].中国药房,2010,21(10):907-909.
[11]戴体俊.麻醉药理学[M].北京:人民卫生出版社,2014.
[12]ARCANGELI A,D'ALOC,GASPARI R.Dexmedetomidine use in general anaesthesia[J].Curr Drug Targets,2009,10(8):687-695.
[13]KOROGLU A,TEKSAN H,SAGIR O,et al.A comparison of the sedative,hemodynamic,and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J].Anesth Analg,2006,103(1):63-67.