颈椎手术患者喉罩辅助纤维支气管镜引导气管插管的效果

Efficacy of fiberoptic bronchoscope-guided tracheal intubation with laryngeal mask airway in patients undergoing cervical spine surgery

目的评价颈椎手术患者喉罩辅助纤维支气管镜引导气管插管的效果。方法择期行前路颈椎手术患者40例，性别不限，年龄18—55岁，体重50～75kg，ASA分级Ⅰ或Ⅱ级，Mallampatis分级Ⅰ或Ⅱ级。采用随机数字表法，将患者随机分为2组（n：20）：纤维支气管镜引导气管插管组（FOB组）和喉罩辅助纤维支气管镜引导气管插管组（LMA组）。麻醉诱导后，进行气管插管。记录气管插管时间和气管导管置人情况；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LMA组喉罩置入情况、置入时间和拔除气管导管时喉罩移位情况。记录拔除喉罩带血和术后咽喉部不良反应的发生情况。结果喉罩1次置人成功率为90％，置入时间为（13±3）s。两组气管插管成功率均为100％。与FOB组比较，LMA组气管插管时间缩短，1次气管插管成功率升高（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、心动过速和低氧血症。LMA组气管导管拔除时有8例（40％）发生喉罩移位；拔除喉罩时1例发生喉罩带血；术后1例发生咽部轻微疼痛；两组均未见其它不良反应的发生。结论颈椎手术患者喉罩辅助纤维支气管镜引导气管插管不仅可确保有效通气，还可提高引导气管插管成功率，明显缩短气管插管时间。

Objective To evaluate the efficacy of fiberoptic bronchoscope （FOB）-guided tracheal intubation with laryngeal mask airway （LMA） in patients undergoing anterior cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-55 yr, weighing 50-75 kg, mallampatisⅠ or Ⅱ, scheduled for anterior cervical spine surgery under general anesthesia, were randomly divided into 2 groups （ n = 20 each） ： FOB- guide tracheal intubation （group FOB） and FOB-guided tracheal intubation with LMA group （group LMA）. Anesthesia was induced with mindazolam 0.04 mg/kg, fentany 3-4 μg/kg, cis-atracuriun 0.2 mg/kg and propofol 2 mg/kg.Tracheal intubation was performed at 3 min after cis-artracurium iv. Auditory evoked potential index was maintained at 10-20. The intubation time, the number of successful intubation, hypertension, tachyeardia and hypoxemia were recorded. The number of successful LMA placement, LMA placement time and LMA shift after extubation were recorded. Blood stain at LMA removal and complications were also recorded. Results The rate of successful LMA placement at first attempt was 90% and placement time was （13 ± 3） s. The rate of successful intubation in the both groups was 100 % . The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group LMA than in group FOB （P 〈 0.05）. Hypertension, taehycardia and hypoxemia were not found in the two groups. The number of LMA shift was 8 （40%）. The number of blood stain and slight sore throat was 1 respectively in group LMA. There was no other complications in the both groups. Conclusion FOB-guided tracheal intubation with LMA can provide effective ventilation during operation, improve the success rate at first attempt and shorten the intubation time in patients undergoing cervical spine surgery.