柔头微创气管导管易于通过气道、减轻损伤的临床研究

The clinical study of the Parker Flex - Tip tube in facilitating passage vocal cord and weakening it＇s mechanical injury on airway

目的研究经光导纤维镜外套柔头微创（Parker Flex-Ⅱp）导管气管插管时导管易于通过声门和减轻对后结构损伤的机制。方法根据气道结构显露情况将119例经口插管麻醉病人分如下两组：Ⅰ组，为Ⅲ-Ⅳ级气道，以光导纤维镜为引导管芯（Stryker；直径2、7mm）26例，外套Parker Flex-Tip导管和普通导管（最大内径=8．5mm）行气管内插管，根据操作者对导管进入声门的难易程度的判断行序贯记数双向配对检验，显著性水准为2α=β=0．01；Ⅱ组，93例，非光导纤维镜插管组，Ⅰ-Ⅱ级气道，用普通导管插管。结果在26例Ⅲ-Ⅳ经光导纤维镜行Parker Flex-Tip导管插管的病人，无一例卡在声带上，经配对检验和普通管相比，Parker Flex-Tip导管优于普通管（P〈0、01）。Ⅱ组病人在导管推进过程中也未遇到阻力，录象画面显示，Parker Flex-Tip导管前端可平滑地越过声带。应用Parker Flex-Tip导管的病人术后均未诉咽喉痛。结论光导纤维镜外套柔头微创导管通过声门时明显降低失败率，使用柔头微创导管消除了术后咽喉痛。

Objective With a soft and central - directing tip tube, the Parker Flex - Tip tube, to study the mechanism of easier passage of the tube to the trachea and smaller risk of impinging on laryngeal structures during fiberoptic tracheal intubation. Methods Accord to the grade of exposure of the airway structure, 119 patients, allocated into one of the two groups for elective anesthesia using oral introtracheal intubation. In group Ⅰ ,26 patients with grade Ⅲ-Ⅳ airway,were intubated using Parker Flex -Tip tube or common endotracheal tube （Portex, largest ID = 8.5mm） through fiberscope（ Stryker; diameter = 2.7mm）. Difficulty in placing the tube was scored according to an objective standardized grading system and easier or more difficult passage of the tube through the fiberscope into the trachea were compared using the paired sequence quality test （2α = β = 0. 01 ）. In group Ⅱ , 93 patients＇ trachea wear intubated with a standard （Portex） tube. Results In 26 grade Ⅲ -Ⅳ airway patients to use of the Parker Flex - Tip tube have no incidence of need for repositioning of the tube during insertion into trachea compared to the standard tube （P 〈0.01 ）. Also in 93 grade Ⅲ -Ⅳ airway patients, no tube meted resistance during passage of the larynx and no patients complained throe throat postoperayively. The video showed that the tip of the Parker Flex - Tip tube climbed the vocal cord smoothly. The Parker Flex - Tip tube did not lead to airway injury. Conclusions During oral fiberoptic intubation, the use of the Parker Flex - Tip tube results in a significantly lower rate of repositioning and repeated attempts at passing the tube into the trachea, compared to a standard endotracheal tube. And also the incidence of sore throat have been reduced markedly.