改良面罩在经鼻快诱导气管插管中的应用

Introduction of A Modified Face Mask in Transnasal Tracheal Intubations with Fast Induction

目的探讨改良面罩在经鼻快诱导气管插管中的应用价值。方法选择ASAⅠ～Ⅳ级60例择期行口腔颌面部肿瘤手术病人,随机分为两组:普通面罩组(普通组,n=30),改良面罩组(改良组,n=30)。两组病人入室后用1%的地卡因作鼻腔表面麻醉和呋麻滴鼻液收缩鼻粘膜。普通组使用常规麻醉面罩加压通气下进行快诱导,在无呼吸情况下再将气管导管穿过鼻腔经声门插入气管。改良组在气管导管通过后鼻孔后,不退出导管,使用改良麻醉面罩加压通气下进行快诱导,诱导后再将气管导管经声门插入气管。记录首次中止面罩给氧至气管插管成功过程中肺通气中断总时间T,和气管插管成功时的SpO2、PETCO2。结果SpO2两组间无显著性差异(P>0.05),但是中止面罩给氧至气管插管成功的时间和PETCO2两组间有显著性差异(P<0.05)。结论在经鼻快诱导气管插管中,使用改良麻醉面罩给氧较普通麻醉面罩明显地缩短了气管插管操作时的肺通气中断时间,从而改善了CO2潴留,减少了发生缺氧性意外的机会;在插管不顺时也可以带管行面罩给氧,导管无需拔出,减少了鼻粘膜损伤的机会;另在插管困难时,可以在机器或人工辅助通气下,同步行支纤镜明视下插管,也减少了在快诱导下经鼻腔气管插管的失败率。

Objective To assess the value of a modified face mask in transnasal tracheal intubations with fast induction. Methods 60 cases of oral and maxillo-facial tumor with ASA Ⅰ-Ⅳ were randomly divided into two groups： after the 1% dicaine was administered for surface anesthesia in nasal cavity, cases in group Ⅰ were fast induced under regular mask and intubated transnasally in a state of transient respiratory arrest, cases in group Ⅱ received fast induction under a modified mask when tracheal tube has already been introduced beyond posterior nasal aperture in a state of spontaneous respiration, then advanced the tracheal tube into tracheal. The duration of respiratory arrest （T）, measurement of SpO2 , PETCO2 at the time of tracheal tube securing were recorded. Result T value and PET CO2 showed significant difference between two groups whereas the SpO2 did not. Conclusion The modified face mask can significantly shorten the duration of respiratory arrest and improve the CO2 retention.