光棒在快诱导经鼻气管内插管中的应用

摘要

目的 探讨光棒在快诱导经鼻气管内插管中应用的可行性、安全性以及适宜的弯曲角度.方法 将72例需行经鼻气管内插管全身麻醉的患者随机分为3组:喉镜组、光棒A组和光棒B组,每组24例.光棒A组将光棒塑形为与气管导管曲度一致的形状,光棒B组将光棒的前端在气管导管套囊后缘将光棒弯曲成60°.记录各组插管一次成功例数、总成功例数和麻醉诱导前、麻醉诱导后、气管插管即刻及气管插管后1,3和5 min时的收缩压、舒张压和心率变化,并随访术后并发症的发生情况.结果 光棒A组与喉镜组插管一次成功率和总成功率均分别为95.8%和100%,差别无统计学意义(P>0.012 5),但光棒A组血流动力学变化较轻(P<0.05),术后并发症较少(P<0.012 5);光棒B组与喉镜组比较,血流动力学变化和术后并发症的发生率差别均无统计学意义,插管总成功率为91.7%,差别无统计学意义(P>0.012 5),但插管一次成功率明显降低(62.5%),差别有统计学意义(P<0.012 5).结论 光棒引导经鼻气管插管的适宜弯曲角度为与气管导管曲度一致的形状,其插管成功率高,血流动力学变化轻,术后并发症少,是可行的、安全的.%Objective To investigate the feasibility and safety of the lightwand in transnasal tra -cheal intubation under rapid sequence induction and search for the appropriate bending angle of lightwand for transnasal tracheal intubation . Methods Seventy-two patients scheduled for nasal intubation were randomly divided into three groups : laryngoscope group , lightwand group A , lightwand group B (n=24 in every group) . The lightwand group A was guided by the lightwand with the same curve as the tracheal tube , while the lightwand group B was guided by the lightwand with a 60 bent angle at the lightwand tip . The rate of first-try success intubation and total success intubation , together with the incidence of airway complications were recorded . Changes of hemodynamic parameters (systolic arterial pressure , SAP;rndiastolic arterial pressure , DAP ; heart rate , HR) were observed at six points :before induction of anesthesia , after induction of anesthesia , during intubation , one minute, three minutes and five minutes after intubation . Results The first-try success intubation rates and total success intubation rates of the laryngo -scope group and the lightwand group A were 95 .8% and 100% respectively , with no significant difference (P>0 .012 5) , while the hemodynamic fluctuation was milder (P<0 .05)and the incidence of airway com-plicatioms was lower (P<0 .012 5) in the lightwand group A . Compared with the laryngoscope group , the first-try success intubation rate was lower in the lightwand group B (62 .5% , P<0 .012 5), although the hemodynamic fluctuation , the incidence of airway complicatioms and the rate of total success intubation had no significant difference . Conclusion Featured with high success intubation rate but slight hemody -namic changes and few complications , lightwand can be used for transnasal tracheal intubation under rapid sequence induction with the same curve as tracheal tube .