颌面外科手术患者视可尼喉镜引导经鼻气管插管的效果

Efficacy of Shikani laryngoscope-guided nasotracheal intubation in patients undergoing maxillofacial surgery

目的 评价颌面外科手术患者视可尼喉镜引导经鼻气管插管的效果.方法 需行经鼻气管插管的颌面外科手术患者100例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重指数＜25 kg/m2.50例术前气道评估基本正常的患者随机分为2组（n=25）：Macintosh喉镜引导气管插管组（M组）和视可尼喉镜引导气管插管组（S1组）.50例张口度≤3 cm,但无面罩通气困难的患者,随机分为2组（n=25）：光导纤维支气管镜引导气管插管组（F组）和视可尼喉镜引导气管插管组（S2组）.麻醉诱导后分别置入喉镜引导气管插管,行机械通气.评价喉部显露程度和气管插管过程中鼻出血程度,记录气管插管成功情况、气管插管时间和术后鼻部并发症发生情况.结果 与M组比较,S1组气管插管成功率、一次气管插管成功率和喉部显露程度升高,气管插管时间缩短,鼻出血程度降低（P＜0.05）,鼻部疼痛、持续出血和鼻塞的发生率差异均无统计学意义（P＞0.05）.与F组比较,S2组气管插管时间缩短（P＜0.05）,气管插管成功率、一次气管插管成功率、喉部显露程度、鼻出血程度和鼻部疼痛、持续出血和鼻塞的发生率差异无统计学意义（P＞0.05）.结论 视可尼喉镜可更好地显露喉部结构,一次气管插管成功率高,更适用于颌面外科手术患者引导经鼻气管插管.

Objective To evaluate the efficacy of Shikani laryngoscope-guided nasotracheal intubation in patients undergoing maxillofacial surgery. Methods One hundred ASA Ⅰ or Ⅱ patients with body mass index ＜25 kg/m2 , aged 18-64 yr, undergoing maxillofacial surgery under general anesthesia requiring nasotracheal intubation were included in this study. Fifty patients without anticipated difficult airway in preoperative assessment were randomly divided into 2 groups （ n = 25 each）： Macintosh luyngoscope group （ group M ） and Shikani Optical Stylet （SOS） group （group S1 ）. The other 50 patients with mouth opening ＜ 3 cm but without difficult ventilation by mask were randomly divided into 2 groups （ n = 25 each）： fiberoptic bronchoscope group （group F） and SOS group （group S2 ）. Tracheal intubation was performed under the guidance of laryngoscopes after induction of anesthesia, and then the patients were mechanically ventilated. The degree of glottis exposure and epistaxis was evaluated. The rate of successful intubation, rate of successful intubation at first attempt, intubation time and complications were recorded. Results Compared with group M, the rate of successful intubation, rate of successful intubation at first attempt, and degree of glottis exposure were significantly increased, the intubation time was significantly shortened, and the degree of epistaxis was significantly decreased （ P ＜ 0.05）, but no significant change was found in the complications in group S1 （ P ＞ 0.05）. Compared with group F, the intubation time was significantly shortened （ P ＜ 0.05）, but no significant change was found in the rate of successful intubation, rate of successful intubation at first attempt and complications in group S2 （ P ＞ 0.05）. Conclusion Shikani laryngoscope can expose glottis better and the rate of successful intubation at first attempt is higher, thus it is more suitable for nasotracheal intubation in patients undergoing maxillofacial surgery.