盲探气管插管装置经口插管在鼻部整形困难气道患者中的应用

Application of orotracheal intubation using blind tracheal intubation device in difficult airway patients receiving nasal plastic surgery

目的通过比较盲探气管插管装置与纤维光导支气管镜引导经口清醒气管插管的应用效果,验证盲探气管插管装置经口插管在行鼻部整形困难气道患者中的临床应用价值。方法 60例接受鼻部整形的困难气道患者,随机分为两组,每组各30例。组Ⅰ采用盲探气管插管装置经口气管插管,组Ⅱ采用纤维光导支气管镜引导经口气管插管。观察两组的气管插管成功率,插管所用时间,循环、呼吸功能变化和并发症情况。结果组Ⅰ插管成功率为100%(30/30);组Ⅱ插管成功率为93.3%(28/30),2例患者失败的原因是张口度过小仅能通过气管导管而无法置入保护牙垫,为防止纤维光导支气管镜的镜干在插管过程中被患者不自主咬合而损坏,改为使用盲探气管插管装置经口插管成功。组Ⅰ的平均插管时间为(4.1±1.3)min,组Ⅱ的平均插管时间为(3.8±1.2)min,两组间的差异无统计学意义(P>0.05)。组Ⅰ插管前的心率(HR)和平均动脉压(MAP)分别为(72±8)次/min和(87±9)mmHg(1mmHg=0.133kPa),均显著低于插管后的(90±10)次/min和(104±12)mmHg(P值均<0.05)。组Ⅱ插管前的HR和MAP分别为(75±10)次/min和(88±7)mmHg,均显著低于插管后的(91±11)次/min和(102±10)mmHg(P值均<0.05)。两组间HR和MAP上升幅度的差异无统计学意义(P值均>0.05)。结论盲探气管插管装置与纤维光导支气管镜引导经口气管插管均具有插管成功率高、操作简便、并发症少的特点。盲探气管插管装置还可用于纤维光导支气管镜难以解决的困难气道插管,且成本较低,可用于接受鼻部整形的困难气道患者的经口气管插管,具有临床推广应用价值。

Objective To assess the clinical value of the blind intubation device in difficult airway patients receiving nasal plastic surgery by comparing the effects of the blind intubation device with fibreoptic bronchoscope for awake orotracheal intubation.Methods Sixty difficult airway patients who were to receive nasal plastic surgery were divided into two groups（n=30）.Group Ⅰ received awake orotracheal intubation with the blind intubation device;Group Ⅱ received fibreoptic bronchoscope for awake orotracheal intubation.The success rates,time of intubation,the changes of circulation and respiration,and complications were all observed in two groups.Results The success rate was 100%（30/30）in group Ⅰ and 93.3%（28/30）in group Ⅱ.The reason for the two unsuccessful cases was the small oral opening which preventing placement of the protective bite-block to avoid damage of bronchoscope stem.Finally,the two cases were successfully intubated using the blind intubation device technique.The mean time of intubation was（4.1±1.3）min in group Ⅰ and（3.8±1.2）min in group Ⅱ,with no significant difference found between the two groups（P〈0.05）.The heart rate（HR）and mean arterial pressure（MAP）were（72±8）/min and（87±9）mmHg（1 mmHg=0.133 kPa）in group Ⅰ before intubation,which were significantly lower than those after intubation（[90±10]/min and [104±12] mmHg,all P〈0.05）.The HR and MAP were（75±10）/min and（88±7）mmHg in group before intubation,which were significantly lower than those after intubation（[91±11] /min and [102±10] mmHg,all P〈0.05）.The increases of HR and MAP were not significantly different between the two groups（P〈0.05）.Conclusion Both fibreoptic bronchoscope technique and blind intubation device have high success rates for intubation and are easy to perform,with few complications.The blind intubation device can also be used for difficult airways that can not be resolved by fibreoptic bronchoscope.Furthermore,the blind intubation device has a lower cost;it can be used for orotracheal intubation in difficult airway patients receiving nasal plastic surgery,and it is worth popularizing.（Shanghai Med J,2010,33：702-704）