双腔支气管改造装置配合EtC02波形图在颈椎骨折病人麻醉插管中的应用

Modified double-lumen endobronchial tubes with EtCO2 oscillogram in anesthetic intubation of Patients with cervical spine fractures

目的 探讨双腔支气管改造成盲探插管装置配合EtCO2（呼气末二氧化碳）波形监测用于解决颈椎骨折病人困难插管的可行性.方法 把颈椎骨折困难插管的病例随机分两组：经口会厌后下方盲探插管组（A组,n=25）和经口双腔支气管改造装置配合EtCO2监测插管组（B组,n=25）.分别进行盲探插管并记录统计插管次数、插管时间（从开始插管到听诊证实成功）、插管过程中追加麻药的次数及各时段的血压（BP）、心率（HR）、氧饱和度（SpO2）变化和插管并发症等.结果 两组病例插管难度评估无明显差异性（P＞0.05）：插管所耗的时间B组为（3.29±1.67）min,明显少于A组的（8.56±4.13）min（P＜0.05）： B组1～2次的成功率92%,明显高于A组的32%（P＜0.05）.无1例发生低血氧症（SPO2＜92%）、呛咳或气管支气管痉挛等插管并发症.结论 双腔支气管改造插管装置配合EtCO2波形图监测用于困难插管,特别对颈椎骨折患者是一种简便、安全、有效的气管插管方法.

Objective To investigate the feasibility of solving incubation difficulty in patients with cervical spine fractures using blind tracheal incubation instrument transformed from double-lumen endobron-chial tubes with EtCO2 （end-tidal carbon dioxide） oscillogram monitoring. Methods Patients with cervical spine fractures suffered incubation difficulty were randomly divided into two groups： blind tracheal intubation group （group A, n = 25） and the group of modified double-lumen endobronchial tubes with EtCO2 monitoring （group B, n = 25）. Blind tracheal incubation was conducted in the two groups. The number of intubation, intubation duration （from the beginning to successful intubation proved by auscultation）, additional uses of anesthetics throughout the intubation period, blood pressure （BP）, heart rate （HR）, changes of oxygen saturation （SpO2）, and intubation complications were recorded, Results There was no significant difference between the two groups in assessment of intubation difficulty （P〉0.05）, the success rate of incubation for 1 to 2 times was significantly higher in group B than in group A （P〈0.05）, changes of BP and of HR were significantly smaller than in group A （P〈0.05）. No hypoxemia （SPO2 〈92%）, bucking, bronchial spasm, and other complications occurred. Conclusions Modified double-lumen ndobronchial tubes with EtCO2 oscillogram monitoring for patients with intubation difficulty, especially for those with cervical fractures, is a simple, safe, and effective procedure of endotracheal intubation, and is worth popularizing.