OSAS患者纤维支气管镜辅助下快诱导经口与慢诱导经鼻气管插管效果的比较

Comparison of efficacy of orotracheal intubation after rapid induction and nasotracheal intubation after slow induction assisted by fiberoptic bronchoscope in patients with obstructive sleep apnea syndrome

目的比较阻塞性睡眠呼吸暂停综合征（OSAs）患者纤维支气管镜（FOB）辅助下快诱导经口与慢诱导经鼻气管插管的效果。方法择期行悬雍垂腭咽成形术的OSAS合并高血压患者40例，ASA11级，年龄38～64岁，体重82—123kg，张口度大于2．5cm，Mallampatis分级Ⅲ或Ⅳ级，随机分为I组和Ⅱ组（n=20），分别采用FOB辅助下慢诱导经鼻气管插管和快诱导经口气管插管。于麻醉诱导后即刻和气管插管后即刻记录MAP和HR；记录两组气管插管时间、气管插管成功情况和气管插管期间心动过速、高血压及心肌缺血的发生情况，以及耳鼻喉科医师对气道管理的满意情况。结果40例患者使用FOB气管插管均成功，I组5例气管插管失败，改为Ⅱ组方法后均首次气管插管成功，Ⅱ组气管插管均成功；与I组比较，Ⅱ组气管插管成功率升高，麻醉诱导后HR和MAP降低，气管插管期间心动过速、高血压及心肌缺血发生率降低，耳鼻喉科医师满意率升高（P〈0．05）；工组有4例气管拔管后出现鼻出血。结论在FOB辅助下，与慢诱导经鼻气管插管比较，OSAS患者采用快诱导经口气管插管时应激反应小，气管插管成功机率高，可避免气道损伤。

Objective To compare the efficacy of orotracheal intubation after rapid induction and nasotrachea/intubation after slow induction assisted by fiberoptic bronchoscope （FOB） in patients with obstructive sleep apnea syndrome （OSAS）.Methods Forty ASA Ⅱ patients with OSAS and hypertension, aged 38-64 yr, weighing 82-123 kg, undergoing uvulopalatopharyngoplasty, were randomly allocated into 2 groups （ n = 20 each） ： group I awake nasotracheal intubation through FOB after slow induction and group Ⅱ orotracheal intubation through laryngoscope and FOB after rapid induction. MAP and HR were recorded immediately after anesthesia induction and intubation. The intubation time was recorded, and rate of successful intubation, incidences of tachycardia, hypertension and myocardial ischemia during intubation, and satisfactory rate of otolaryngologists with airway management were calculated. Results The rate of successful intubation were significantly higher, MAP and FIR after induction were significantly lower, incidences of tachycardia, hypertension and myocardial ischemia during intubation were significantly lower, and satisfactory rate of otolaryngologists was significantly higher in group 11 than in group I （ P 〈 0.05）. Four patients in group I had nasa/ bleeding after extubation. Conclusion Orotracheal intubation after rapid induction assisted by FOB provides less hemodynamic response to endotracheal intubation and higher success rate with less injury to the airway in patients with OSAS than nasotracheal intubation after slow induction assisted by FOB.