柔头微创气管导管的临床应用研究

The clinical study of the Parker Flex-Tip tube

目的研究经光导纤维镜外套柔头微创导管（ParkerFlex-Tip，Tube）（PFTT）气管插管时导管易于通过声门和减轻对组织结构损伤的机制。方法根据气道结构显露情况将175例经口插管麻醉病人分如下两组：Ⅰ组，26例，为光导纤维镜插管组，Ⅲ～Ⅳ级气道，以光导纤维镜为引导管芯（Stryker；直径2．7mm），外套PFT导管（最大内径=8．5mm）和普通导管行气管内插管，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，149例，为非光导纤维镜插管组，Ⅰ～Ⅱ级气道，选用PFT导管插管93例，选用普通导管插管56例。结果在13例Ⅲ～Ⅳ气道经光导纤维镜行PFT导管插管的病人，经配对检验和普通管相比，PFT导管优于普通管（P〈O．01）。Ⅱ组病人在导管推进过程中也未遇到阻力，视屏显示，PFT导管前端可平滑地越过声带。应用PFT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，使用柔头微创导管术后咽喉痛发生率显著减少。

Objective To analyze the clinical use of the Parker Flex-Tip tube. Methods Accord to the grade of exposure of the airway structure, 175 patients were allocated into two groups. In group 1,26 patients with grade Ⅲ-Ⅳ airway, were intubated with PFT tube or common endotracheal tube （Portex, largest ID= 8.5mm） through fiberscope （Stryker; diameter=2.7 mm）. 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. In groupⅡ, there was 149 patients. 93 patients＇trachea were intubated with PFT tube. 56 patients＇trachea were intubated with common tube. Results In thirteen grade Ⅲ-Ⅳ airway patients, the use of the PFT 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 patients with PFT tube, no tube meted resistance during passage of the larynx and no patients complained throe throat after operation. The video showed that the tip of the PFT tube climbed the vocal cord smoothly. The PFT tube did not lead to airway injury. Conclusions During oral fiberoptic intubation, the use of the PFT tube resuits in a significantly lower rate of repositioning and repeated attempts at passing the tube into the trachea, compared to a standard endotracheal tube.