不同辅助手法对Bonfils纤维光导硬镜引导气管插管的影响

Effects of Different Manual Airway Maneuvers on Bonfils Intubation Fiberscope-guided Tracheal Intubation

目的比较不同辅助手法下Bonfils纤维光导硬镜气管插管的效果。方法选择本院经口气管插管全身麻醉下实施择期整形外科手术成年患者90例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ～Ⅱ级,按不同辅助手法随机分为A组(常规操作,即头颈伸展位)、B组(单人提下颌)和C组(助手托下颌)。常规麻醉诱导后,采用Bonfils纤维光导硬镜实施气管插管,记录气管插管的操作次数、操作时间、血流动力学变化、插管所致气道损伤和术后咽痛等不良反应。结果 90例患者均一次气管插管成功,A、B和C组的操作时间分别平均为(44.6±38.9)、(33.7±29.4)和(18.9±10.3)s,C组与A、B组比较差异均有统计学意义(P<0.05);三组患者血流动力学变化相近。A、B和C组术后咽痛或不适分别为12、11和7例;A组上唇损伤1例,其余2组未发生口咽部组织损伤。结论 Bonfils纤维光导硬镜在不同辅助手法下行气管插管时,采用助手托下颌的操作时间最短,插管损伤最小。

Objective To compare the effects of different manual airway maneuvers on Bonfils intubation fiberscope-guided tracheal intubation.Methods Totally 90 adult patients with ASA class Ⅰ-Ⅱ who were planning to undergo elective plastic surgery and requiring orotracheal intubation were allocated into three groups：Group A（routine operation）,Group B（chin lift）,and Group C（external jaw thrust）.After intravenous anesthesia induction,all patients were intubated with Bonfils intubation fiberscope.The number of intubation attempts,duration of each intubation attempt,hemodynamic changes,incidence of intubation-related intraoral injury,and postoperative sore throat and other complaints were recorded.Results All patients were successfully intubated at the first attempt.The duration of intubation was significantly short in Group C（18.9±10.3） s than in Group A（44.6±38.9） s and Group B（33.7±29.4） s（P0.05）.The hemodynamic changes were similar among three groups.The incidence of postoperative sore throat and hoarseness in Group A,B,and C were 12,11,and 7 patients,respectively.One patient in Group A suffered from injury to the upper lip.Conclusions Bonfils intubating fiberscope is easy to manipulate with high success rate.Both chin lift and external jaw thrust can shorten intubation time,whereas external jaw thrust can help to achieve the shortest intubation time with minimal injury to oral cavity.