已预料困难气道患者在清醒镇静表面麻醉下气管插管方式的选择

摘要

Objective To observe the effects of fiber bronchoscope versus video laryngoscopy in tracheal intubation for patients with anticipated difficult airway .Methods 46 patients with American Society of Anesthesiologists (ASA) Grade I-II anticipating difficult airway planning to receive elective surgery were randomized using random number table into the fiber bronchoscope group or video laryngoscopy group , each consisting of 23 patients, to receive tracheal intubation under fiber bronchoscope or video laryngoscopy .Blood pressure and heart rate at 5 min following stabilization in operation room ( T0 ) , 10 min following sedation ( T1 ) , at the time of tracheal intubation ( T2 ) , 1 min following tracheal intubation ( T3 ) , 2 min fol-lowing tracheal intubation ( T4 ) , and 3 min following tracheal intubation ( T5 ) , PetCO2 following tracheal intubation , intuba-tion success rate , the duration of tracheal intubation and sore throat , hoarseness 24 h post-surgery were observed and recorded for both groups .Results Intubation was successful at the first attempt , contributing to the 100% intubation success rate in both groups .The duration of tracheal intubation under fiber bronchoscope was significantly longer than that under video laryn -goscopy, with statistically significant difference (P0.05 ) .Conclusion Both fiber bronchoscope and video laryngoscopy can apply to patients with anticipated difficult airway who had undergone conscious sedation and surface anesthesia , resulting in comparable haemodynamics;however , the duration of tracheal intubation under fiber bronchoscope is significantly longer than that under video laryngoscopy .%目的：观察纤维支气管镜和可视喉镜在已预料困难气道患者气管插管中的应用效果。方法选择行择期手术美国麻醉协会麻醉分级（ ASA）Ⅰ～Ⅱ级的已预料困难气道46例，应用随机数字表法随机将其分为纤维支气管镜组（采用纤维支气管镜进行气管插管）及可视喉镜组（采用可视喉镜进行气管插管）两组各23例。观察记录两组入室稳定5 min后（T0）、镇静10 min后（T1）、气管插管即刻（T2）、气管插管后1 min（T3）、气管插管后2 min（T4）和气管插管后3 min（ T5）时的血压和心率，气管插管后呼气末二氧化碳分压，插管成功率，气管插管用时以及术后24 h发生咽喉痛、声音嘶哑情况。结果两组均1次插管成功，插管成功率均为100％。纤维支气管镜组气管插管用时明显长于可视喉镜组，差异有统计学意义（ P＜0.05）。术后24 h纤维支气管镜组发生咽喉痛2例、声音嘶哑1例；可视喉镜组发生咽喉痛1例、声音嘶哑1例。 T1时两组血压及心率均较T0时降低，其中T1时纤维支气管镜组血压及心率、可视喉镜组仅舒张压与T0时比较差异有统计学意义（ P＜0.05）。 T2、T3、T4时两组血压及心率均较T0和T1时升高，除纤维支气管镜组和可视喉镜组T4时及可视喉镜组T2时心率与T0时比较差异无统计学意义外，余差异均有统计学意义（ P＜0.05）。纤维支气管镜组收缩压及心率、可视喉镜组舒张压T5时与T0时比较差异亦均有统计学意义（ P＜0.05）。两组血压及心率各时间点组间比较差异均无统计学意义（ P＞0.05）。结论纤维支气管镜及可视喉镜均适用于清醒镇静表面麻醉下已预料困难气道患者气管插管，且患者血流动力学反应相似，但气管插管用时纤维支气管镜明显长于可视喉镜。