困难气道患者经鼻纤支镜引导插管的护理配合

Nursing care in fiberbronchoscope-guided intubation in patients with difficult airway access

目的探讨困难气道患者经鼻纤支镜引导插管护理配合要点。方法分析25例预测为困难气道患者的经鼻纤支镜引导插管过程，总结护理配合要点。结果插管前建立通畅的静脉通路，术前禁食禁水2h，向患者做好解释。插管前30min测血气，术前纯氧吸入10min，做好镇静加表面麻醉，护士双手协助固定患者头部。纤支镜进入鼻腔后，观察生命体征，动脉血氧饱和度SpO2低于85％时应立即向操作者汇报，暂缓操作，退出纤支镜，纯氧吸入。若需吸痰，调节负压不宜超过-16．0～10．7kpa，气管导管推送到合适深度后才能退出纤维镜。术后给患者安置舒适体位，加强并发症的观察。检查后的不适会维持一段时间，可予镇静剂维持2-3h。插管后30min复查血气。术后2h内禁食禁水。23例置管成功。插管时间均〈5min，无严重并发症发生。插管后血气PaO2（80．56±0．22）mmHg、PaCO2（53．47±0．66）mmHg，均显著高于插管前（58．95±0．08）mmHg和（71．25±0．76）mmHg，均P〈0．051。结论对于困难气道的患者，恰当的护理配合有助于提高纤支镜引导插管的成功率。

Objective To discuss the nursing care in nasal fiberbronchoscope-guided intubation for patients with difficult tracheal access. Methods The clinical data of 25 patients undergoing nasal fiberbronchoscope-guided bronchial intubation who were estimated to be with difficult tracheal access were analyzed. Results Before the intubation a free venous pathway was established, fasting and water deprivation were conducted for 2 h. 30 min and 10 min before the intubation blood gas was examined and pure oxygen was inhaled respectively. Surface anesthesia and sedative was given. The nurses were to hold the heads of the patients. After the fiberbronchoscope was inserted into the nasal cavity, the life signs were observed. If the arterial oxygen saturation （SpO2） was lower than 85% it should be reported to the physician. If sputum suctioning was needed the negative pressure should not exceed-16.0-10.7 kpa. The fiberbronchoscope was pulled out only after the bronchial tube was pushed to a proper depth. After the operation comfortable position was adopted and observation of complications was strengthened. The feeling of uneomfortableness lasted a period of time, sedative should be given. 30 min after the operation blood gas examination was repeated. Fasting and water deprivation were carried out for 2 hours. Successful intubation was seen in 23 cases with an average intubation time of less than 5 min. The arterial oxygen tension and arterial CO2 tension （Pa-CO2） after intubation were （80.56± 0.22） mmHg and （53.47 ±0.66） mmHg respectively, both significantly higher than those before intubation [（58.95 ±0.08 ） mmHg and （71.25±0.76） mmHg respectively, both P〈0.05]. One case with nasal deformity that had not been found in advance was turned to oral fiberbronchoscope-guided intubation, and one case had to receive traeheotomy because blood obstructed the view of eyepiece. No serious complication was found. Conclusion Proper nursing care helps raise the success rate of fiberbronchoscope-guided intubation for the patients with difficult airway access.