肩下垫枕仰卧位时插管软镜在困难气道患者经鼻插管中的临床应用

doi:10.13481/j.1671-587x.20170429

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (04): 818-821.doi: 10.13481/j.1671-587x.20170429

肩下垫枕仰卧位时插管软镜在困难气道患者经鼻插管中的临床应用

李宦臻, 丁皓月, 赵保建, 李刚, 房方方, 董迎春

南京大学医学院附属口腔医院江苏省南京市口腔医院麻醉科, 江苏南京 210008

收稿日期:2016-10-04 出版日期:2017-07-28 发布日期:2017-08-01
通讯作者: 董迎春,副教授,副主任医师,硕士研究生导师(Tel:025-83620337,E-mail:dongyingchun1001@hotmail.com) E-mail:dongyingchun1001@hotmail.com
作者简介:李宦臻(1991-),男,辽宁省盘锦市人,在读口腔医学硕士,主要从事口腔颌面部疼痛方面的研究。
基金资助:
国家自然科学基金资助课题（81100768）；人社部留学人员科技活动择优项目资助课题（2015-192）；江苏省卫计委"科教强卫工程"医学青年人才项目资助课题（QNRC2016117）；江苏省南京市医学科技发展专项资金资助课题（YKK11040）

Clinical application of flexible endoscope assisted by pillow-under-shoulder in patients with difficult airway

LI Huanzhen, DING Haoyue, ZHAO Baojian, LI Gang, FANG Fangfang, DONG Yingchun

Department of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China

Received:2016-10-04 Online:2017-07-28 Published:2017-08-01

摘要/Abstract

摘要： 目的：观察一般仰卧位和肩下垫枕仰卧位时插管软镜在困难气道患者经鼻插管中的临床应用，探讨插管体位对插管效果的影响。方法：选取行口腔颌面外科手术的困难气道患者168例，采用随机数字表法分为一般仰卧位组（对照组）和肩下垫枕的仰卧位组（实验组），每组84例，全身麻醉下行经鼻气管内插管。记录2组患者首次插管成功率、总成功率、插管时间和插管时直接看到声门的比率，同时记录2组患者在麻醉诱导前、插管前、插管过程中和插管后1 min和5 min时平均动脉压（MAP）、心率（HR）和插管并发症。结果：实验组患者首次插管成功率（94.0%，79/84）明显高于对照组（71.4%，60/84）（P<0.01）；实验组患者插管总成功率（98.8%，83/84）与对照组（97.6%，82/84）比较差异无统计学意义（P>0.05）。与对照组比较，实验组患者插管时间明显缩短（P<0.01），插管软镜通过鼻后孔后不需要调整按钮即能直接看到声门的比率明显升高（P<0.01）。与基础值比较，2组患者在插管前和插管过程中MAP和HR均明显降低（P<0.01），插管后1 min和5 min时回到基础值（P>0.05）；2组患者在各时间点MAP和HR比较差异均无统计学意义（P>0.05）。术后2组患者明显咽痛、声音嘶哑和鼻出血等并发症的发生率比较差异无统计学意义（P>0.05）。结论：肩下垫枕可使插管软镜在困难气道患者经鼻插管中应用的成功率更高，用时更短。肩下垫枕仰卧位是插管软镜经鼻插管时一个较好的操作体位。

关键词: 插管软镜, 肩下垫枕, 困难气道, 经鼻插管

Abstract: Objective: To observe the clinical application of flexible endoscope assisted by general versus pillow-under-shoulder supine position in nasotracheal intubation of the patients with difficult airway, and to explore the influence of intubation position in the intubation effect.Methods: A total of 168 patients with difficult airway who underwent nasotracheal intubation and oromaxillofacial surgery under general anesthesia were randomly divided into general supine position (control group) and pillow-under-shoulder supine position (experimental group) with 84 cases in each group. The first-time and the total success rate of intubation, the intubation time, and the rate of direct glottis exposure of the patients in two groups were recorded. The mean arterial pressure(MAP), heart rate (HR), and complications of intubation of the patients in two groups before induction, before tracheal intubation, during intubation, 1 and 5 min after intubation, were also recorded.Results: The first-time success rate of intubation in experimental group (94.0%, 79/84) was significantly higher than that in control group (71.4%, 60/84) (P<0.01); the total success rate of intubation (98.8%, 83/84) had no difference compared with control group (97.6%, 82/84) (P>0.05); the intubation time (57 s±12 s) was significantly shorter than that in control group (146 s±29 s) (P<0.01); the rate of direct glottis exposure (47.6%, 40/84) when the flexible endoscope passed through the posterior nasal apertures was obviously higher than that in control group (15.5%, 13/84) (P<0.01).The values of MAP and HR of the patients in two groups before and during intubation were decreased significantly compared with the baselines (P<0.01), and came back to the baselines 1 and 5 min after intubation (P>0.05). There were no significant differences in the MAP and HR between different time points (P>0.05). The incidence rates of complications including pharyngalgia, hoarseness and epistaxis had no differences between two groups (P>0.05).Conclusion: Flexible endoscope assisted by pillow-under-shoulder in nasotracheal intubation has a higher intubation success rate, shorter intubation time and it is a superior procedure for the patients with difficult airway.

Key words: flexible endoscope, pillow-under-shoulder, difficult airway, nasotracheal intubation

中图分类号:

R614.2

李宦臻, 丁皓月, 赵保建, 李刚, 房方方, 董迎春. 肩下垫枕仰卧位时插管软镜在困难气道患者经鼻插管中的临床应用[J]. 吉林大学学报(医学版), 2017, 43(04): 818-821.

LI Huanzhen, DING Haoyue, ZHAO Baojian, LI Gang, FANG Fangfang, DONG Yingchun. Clinical application of flexible endoscope assisted by pillow-under-shoulder in patients with difficult airway[J]. Journal of Jilin University Medicine Edition, 2017, 43(04): 818-821.

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肩下垫枕仰卧位时插管软镜在困难气道患者经鼻插管中的临床应用

Clinical application of flexible endoscope assisted by pillow-under-shoulder in patients with difficult airway

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