颈椎手术患者i-gel喉罩辅助纤维支气管镜引导气管插管的效果

Efficacy of fiberopfic bronchoscope-guidcd tracheal intubation with laryngeal mask airway iogel in patients undergoing cervical spine surgery

目的 评价颈椎手术患者i-gel喉罩辅助纤维支气管镜引导气管插管的效果.方法 择期全麻气管插管的颈椎手术患者40例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄36～62岁,体重57～78 kg,身高165～177 cm,Mallampati分级Ⅰ～Ⅲ级,随机分为2组（n=20）：口咽通气道辅助FOB引导气管插管组（O组）和i-gel喉罩辅助FOB引导气管插管组（I组）.麻醉诱导后,进行气管插管.记录气管插管时间、纤维支气管镜咽部解剖结构显露分级、气管插管置人情况;记录气管插管期间高血压、心动过速和低氧血症的发生情况;记录拔除喉罩带血和术后咽喉部不良反应的发生情况.结果 i-gel喉罩均1次置入成功,置入时间为（10±3）s,两组气管插管成功率均为100%;与O组比较,I组气管插管时间缩短,1次气管插管成功率升高,纤维支气管镜咽部解剖结构显露分级升高（P＜0.05）.两组气管插管期间血液动力学稳定,均未发生高血压和心动过速和低氧血症,I组仅1例喉罩粘血,两组均未见其他不良反应发生.结论 颈椎手术患者i-gel喉罩辅助纤维支气管镜引导气管插管不仅可确保有效的通气,而且可提高引导气管插管成功机率,缩短操作时间.

Objective To evaluate the efficacy of fiberoptic bronchoscope （FOB）-guided tracheal intubation with laryngeal mask airway i-gel （LMA i-gel） in patients undergoing cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients, aged 36-62 yr, weighing 57-78 kg, scheduled for cervical spine surgery under general anesthesia, were randomly divided into 2 groups （n = 20 each）： FOB-guided tracheal intubation with oropharynx ventilation tube group （group O） and FOB-guided tracheal intubation with LMA i-gel （group I）. Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 2-3 μg/kg and rocuronium 0.9 mg/kg. The intubation time, fiberoptic bronchoscope score, the number of successful intubation, hypertension, tachycardia and hypoxemia were recorded. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness, etc. Results The rate of successful LMA i-gel placement at first attempt was 100%, placement time was （10 ＋ 3） s, and the rate of successful intubation in the two groups was 100%. The intubation time was significantly shorter, the rate of successful intubation at first attempt and fiberoptic bronchoscope score were significantly higher in group I than in group O （P 〈 0.05）. Hypertension, tachycardia and hypoxemia were not found in the two groups. There was no significant difference in the incidence of adverse effects between the two groups （P 〉0.05）. Conclusion FOB-guided tracheal intubation with LMA i-gel can provide adequate ventilation during operation, improve the success rate of FOB-guided intubation and shorten the intubation time in patients undergoing cervical spine surgery.