中心静脉导管导丝气管穿刺逆行导引气管插管60例

摘要

目的 探讨中心静脉导管导丝环甲膜下气管穿刺逆行导引气管插管的可行性及临床应用价值.方法 选择逆行气管插管患者60例,ASAⅡ～Ⅲ,随机分为2组,每组各30例.A组予一次性中心静脉包中中心静脉导丝逆行导引,B组予一次性硬膜外穿刺包中硬膜外导管逆行导引.观察逆行导引插管一次性成功率,插管时间,对心血管系统的影响及并发症的发生.检测麻醉诱导前(T0)、诱导后置入导引导丝后即刻(T1)、气管插管后即刻(T2)、退出导引导丝即刻(T3)的收缩压( systolic pressure,SP),舒张压(diastolic pressure,DP)及HR.结果 插管成功率100％.A组从诱导开始到退出导引导丝时间为(220.5±25.6)s,快于B组从诱导开始到退出导引导丝时间(430.7 ±24.3)s,P＜0.05.两组间T0、T3相比,无显著差异(P＞0.05).B组中T1、T2的SP、DP和HR较A组显著升高,有统计学差异(P＜0.05).组内与T0比较,A组的SP和HR在T2明显升高(P＜0.05),而DP各时点均无明显变化(P＞0.05)；B组的SP、DP和HR均在T1、T2明显升高(P＜0.05).插管时患者SPO2均在98％以上.结论 中心静脉导管导丝环甲膜下气管穿刺逆行导引气管插管可安全有效地用于逆行引导气管插管.%Objective To discuss the feasibility and clinical value of retrograde introducer by sub-crico-thyreoidea puncture with central venous catheter guider in difficult intubation. Methods Participants were randomly divided into 2 groups, to which both were applied with retrograde introducer by sub-cricothyreoidea puncture in difficult intubation. Group A ( n = 30) was punctured with central venous catheter guider; while Group B (n =30) was punctured with epidural catheter. Results The success intubation rate was 100% . The interval between the induction beginning to the guiding wire exitting was (220. 5 ±25. 6) s in Group A, which was faster than (430.7 ±24.3) s of Group B (P <0.05). The systolic pressure(SP) ,diastolic pressure (DP)and heart rate(HR) at Tl and T2 was significantly higher than that of Group B(P <0. 05). The intra-group comparison showed SP and HR at T2 significantly increased in Group A(P <0. 05) , while DP had no obvious change (P > 0.05). In Group B, SP and DP and HR at Tl and T2 significantly increased (P < 0.05 ). The SPO2 in intubation was above 98% . Conclusion It is safe and effective of the sub-cricothyreoidea puncture with central venous catheter guider for retrograde introducer in difficult intubation.