McCoy喉镜联合纤维光导支气管镜经鼻气管插管用于全麻诱导后困难插管

Application of nasotracheal intubation with the McCoy laryngoscope combined with fiberoptic bronchoscope in difficult intubation after induction of general anaesthesia

目的:观察McCoy喉镜联合纤维光导支气管镜(FOB)经鼻气管插管在全身麻醉诱导后困难气管插管中应用的临床效果。方法:将40例ASAⅠ或Ⅱ级全身麻醉诱导后McCoy喉镜窥喉不能看见声门任何部分的患者随机均分为两组(n=20):FOB经鼻插管组(对照组)和McCoy喉镜联合FOB经鼻插管组(研究组)。观察并记录两组麻醉诱导前(T0,基础值)、首次插管前(T1)、插管成功即刻(T2)和插管成功后1min(T3)的收缩压(SBP)、舒张压(DBP)和心率(HR)。统计两种方法插管一次成功率、多次成功率、插管耗时和插管并发症。结果:T0、T1、T2、T3等时点两组间SBP、DBP和HR经比较差异无统计学意义(P>0.05);气管插管一次成功率研究组(100%)高于对照组(75%)(P<0.05),多次成功率均为100%;插管耗时研究组(103±25)s较对照组(178±47)s短(P<0.05),两组间插管并发症经比较差异无统计学意义(P>0.05)。结论:McCoy喉镜联合FOB经鼻气管插管成功率高,耗时短,可作为全麻诱导后困难插管时插管方法之一。

Objective To observe the effect of nasotracheal intubation with the McCoy laryngoscope combined with fiberoptic bronchoscope （NIMLFB） in difficult intubation after induction of general anesthesia. Methods Forty patients expose glottis after induction of general anesthesia with McCoy laryngoscope, were divided into two groups： patients of nasotraeheal intubation with fiberoptic bronchoscope （Group F） and the McCoy laryngoscope combined with fiberoptic bronchoscope （Group C）.Systolic blood pressure （SBP） and diastolic blood pressure （DBP）, heart rate （HR） were determined before anesthesia induction （T0）, before intubation for the first time （T1）, the instance after intubation （T2） and lmin after intubation （T3）. We also assayed the rate of the first successful intubation, the total rate, the time of intubation and the complications after this treatment. Results All the patients were successfully intubated in the two groups.There were no difference of SBP, DBP and HR between the two Groups （P 〉 0.05）. The rate of first successful intubation in Group C （100%） was significantly higher than that in Group F （75%）（P 〈 0.05）. The time of intubation in Group C （103 ± 25）s was significantly shorter than that in Group F（178 ± 47）s（P 〈 0.05）, however there were no difference of rates of complications between the two groups. Conclusion NIMLFB can be regarded as one of the preferred means in difficult intubation after general anesthesia induction for its high success and short time.