弹性橡胶探条用于引导双腔支气管导管插管的对比研究

摘要

Objective To investigate the feasibility of elastic gum bougie (Bougie) to guide the insertion of double lumen endotracheal tube (DLET). Method Totally 60 patients, who needed DLET intubation and direct laryngoscopy for thoracic surgery in our department from February to August 2010, were enrolled in this study. All the patients had Ⅱ - Ⅲ grade Cormack-Lehane airway score. They were randomly divided into 2 groups: SI (Standard DLET intubation was performed) and BI ( Bougie was used for intubation) groups with 30 in each. After being oxygenated with pure oxygen for 5 minutes, the patients were induced with midazolam 0.05 mg/kg, fentanyl 3 μg/kg, lidocaine 40 mg, propfol 1.5 -2 mg/kg and esmeron 0.6 mg/kg via intravenous injection. When the muscle relaxed completely, a DELT was placed with a styler or Bougie respectively in SI and BI groups. And then we monitored and recorded the HR and MAP during induction, as well as the time to accomplish intubation and one-time success rate of intubation.Complications related to the intubation were compared between the two groups afterwards. Results Compared with pre-induction,HR and MAP went down obviously after anesthesia induction in both the groups (P ＜ 0.01 ), and then began to increase at 1 minute after intubation(P ＜0.05), and recovered to a normal range at 3 minute. The time required for induction was (5.1 ±0.8) min and (5.9 ± 0.9) min respectively in the SI and BI groups ( t = 3.423, P = 0.542 ). In the BI group, one-time success rate of intubation was 96.7％ , which was significantly higher than that in the SI group ( 80.0％ , x2 = 4.043, P = 0.044). Conclusion Bougie can be safely applied in guiding double-lumen endotracheal intubation.%目的 探讨弹性橡胶探条应用于引导双腔支气管导管插管的可行性.方法 选择2010年2～8月需行双腔支气管导管插管、直接喉镜显露Cormack-Lelane气道分级Ⅱ～Ⅲ级的胸科手术60例,随机分为常规双腔支气管导管插管组(SI)和经弹性橡胶探条引导双腔支气管导管插管组(BI),每组各30例.吸纯氧5 min后,静脉顺序给予眯达唑仑0.05mg/kg、芬太尼3μg/kg、利多卡因40 mg、丙泊酚1.5～2 mg/kg和罗库溴铵0.6 mg/kg麻醉诱导,肌松完善后直接喉镜下分别经铝制管芯(SI组)或弹性橡胶探条(BI组)引导双腔管插管.观察诱导插管期间心率(HR)和平均动脉压(MAP)变化,记录2组完成诱导时间和气管插管一次成功率,比较2组术后气管插管相关并发症发生率.结果 与诱导前比较,2组HR和MAP在麻醉诱导后均明显下降(P＜0.01＝,插管后1 min,2组HR和MAP上升(P＜0.05＝,插管后3 min恢复至诱导前水平.2组完成诱导时间分别为:SI组(5.1±0.8)min,BI组(5.9±0.9)min(t=3.423,P=0.542).BI组气管插管一次成功率(96.7%)明显高于sI组(80.0%)(χ2=4.043,P=0.044).术后SI组有14例出现喉痛,而BI组仅为6例(χ2=4.800,P=0.028).结论 弹性橡胶探条可安全应用于引导双腔支气管导管插管.