纤维喉镜引导经鼻清醒插管麻醉在阻塞性睡眠呼吸暂停综合征术中的应用

摘要

Objective To explore the effect of nasotracheal intubation led by the fiberoptic laryngoscopy on obsteuctive sleep apnea hypopnea syndrome patients with conscious sedation supreficial anesthesia.Methods 90 severe OSAHS patients were received selective uvulopalatopharyngoplasty with general anesthesia in Weishan District Hospital of People's Hospital of Dongyang City.All patients were randomly divided into two groups (n =45),the patients were treated with blind nasotracheal intubation (group A) and nasotracheal intubationt led by the fiberoptic laryngoscopy (group B) separatedly in the state of conscious sedation and supereficial anesthesia.The basic record was made as T0.Values of MAP,HR was dynamically monitored and recorded before intubation as T1,1 min after intubation as T2,2 min as T3,3 min as T4.Concentration of Cortisol,adrenaline and noradrenal in the serun at T1,at T2,at T3,at T4 was made.Intubation time,the situation of successful intubation and the state of myocardial ischemia and nose blooding during intubation were recorded.Results Compared with group A,MAP declined at T2 and T3 in group B,HR declined at T2 in group B [(116±8) mm Hg vs (130±6) mm Hg,1 mm Hg=O.133 kPa; (108±10) mm Hg vs (121±9) mm Hg],the difference was statistically significant (P ＜ 0.05).Adrenaline concentration at T2 and T3 in group Bobviously declined [(145±34) ng/mL vs (174±37) ng/mL; (137±29) ng/mL vs (154±31) ng/mL],the difference was statistically significant (P ＜ 0.05).Noradrenal concentration at T2 and T3 in group Bobviously declined [(153±31)ng/mL vs (184±23) ng/mL;(135±19) ng/mL vs (149±27) ng/mL],the difference was statistically significant (P ＜ 0.05).Compared with group A,intubation time in group B obviously declined [(72±11) s vs (91±14) s],intubation success rate in group B [(100.0％ vs 86.7％)] was obviously higher.Less high blood pressure response and less tachycardia during intubation were in group B compared with group A,the difference was statistically significant (P ＜ 0.05).Conclusion Nasotracheal intubation led by the fiberoptic laryngoscopy lessens the stress reaction on OSAHS patients with conscious sedation and supreficial anesthesia,it provides a more comfortable way of intubation to patients.%目的 探究阻塞性睡眠呼吸暂停综合征(OSAHS)患者在清醒镇静表面麻醉下经纤维喉镜引导经鼻气管插管的效果方法.方法 选择于浙江省东阳市人民医院巍山分院择期全麻下行悬雍垂腭咽成形术的中重度OSAHS患者90例,将90例患者分为A、B两组,A组45例患者采用盲探经鼻气管插管,B组45例患者采用纤维喉镜引导下经鼻气管插管.监测并记录患者基础值(T0)、插管前(T1)、插管后1 min (T2)、2 min (T3)、3 min (T4)时刻的的平均动脉压(MAP)、心率(HR),并于各个时刻取血检测肾上腺素(E)和去甲肾上腺素(NE)的浓度,记录两组患者的插管时间、插管成功情况和插管间心血管反应及插管并发症等的发生情况.结果 B组患者在T2、T3时的MAP水平较A组明显降低[(116±8)mm Hg比(130±6)mm Hg,1 mm Hg=0.133 kPa; (108±10)mm Hg比(121±9)mm Hg],差异有统计学意义(P＜0.05).B组患者在T2、T3时刻的血清E浓度较A组明显降低[(145±34)ng/mL比(174±37)ng/mL;(137±29)ng/mL比(154±31)ng/mL],差异有统计学意义(P＜0.05).B组患者在T2、T3时刻的血清NE浓度较A组明显降低[(153±31) ng/mL比(184±23) ng/mL；(135±19) ng/mL比(149±27)ng/mL],差异有统计学意义(P＜0.05).与A组比较,B组的插管时间明显缩短[(72±11)s比(91±14)s],且插管成功率高(100.0％比86.7％),高血压反应和心动过速的发生率较低,两组间差异具有统计学意义(P＜0.05).结论 纤维喉镜引导下经鼻气管插管减轻了清醒镇静表面麻醉下OSAHS患者插管的应激反应,血流动力学相对稳定,成为临床OSAHS患者较适宜的经鼻插管方法.