发光管芯引导插管在感染手术气道处理中的应用

The Application of Light Wand Intubation in Infection Surgery

目的：观察和评估发光管芯在感染手术患者麻醉常规气管内插管和预测困难气管内插管的适用性与安全性,并比较改变光棒前端弯曲角度的临床实用效果。方法：选择136例ASA I~Ⅲ级全麻下行择期手术的肝炎后肝硬化患者,其中正常气道120例,可顺利气管插管,120例患者按照插管时弯曲光棒角度不同随机分为A组（60°）和B组（90°）;困难气道插管患者分为C组（90°）。分别记录各组插管时间、插管次数、插管的成功率、插管期间血流动力学变化以及术后并发症情况,同时测量医生与患者呼吸道之间的距离。结果：A、B和C组的一次插管成功率分别为100%、96.6%和81.2%,时间分别为（12.3±3.8）s、（13.2±4.1）s和（18.2±5.5）s,三组各自的插管总成功率均为100%。而且改变光棒前端角度的A组插管时间均较B、C组短,发现光棒插管对循环功能的影响小,术后并发症少,医生与患者呼吸道之间的距离为（34±4）cm。结论：在感染手术患者气管插管过程中使用发光管芯引导插管成功率高、对患者的循环影响低且术后并发症少,更为重要的是降低了医务人员与传染性患者近距离接触的机率。

Objective： To observe the clinical effect and reliability of lightwand in routine endotracheal intubation for infection operations and its feasibility to predict the difficult endotracheal intubation.Methods： According to Mallampati test,136 liver cirrhosis patients（ASAⅠ-Ⅲ） were randonmized to three groups： 120 amidst with normal airway were randomly divided into group A（60°） and group B（90°） according to the bent angle of the lightwand tip,and the other 16 predicted with difficult tracheal intubation were allocated into group C.The time,frequency and success rate of each intubation and Changes of hemodynamic fluctuation and the distance of contiguous respiratory tract of medic and patient,the complications arised during this period were observed.Results： The first-time intubation success rate of group A,B,and C was 100%,96.6%,81.2%respectively,while the total intubation success rate of all the three groups was 100%.The time used for a complete intubation in A,B,C was（12.3±3.8）s,（13.2±4.1）s,（18.2±5.5）s accordingly,from which,we can find that the time spent by group A is less than group B or C on light spot searching,lightwand withdrawing and trancheal intubating,and the interference of lightwand intubation against hemodynamic circulatory was slight and complications afterwards were low.the distance of contiguous respiratory tract of medic and patient were（34±4） cm.Conclusion： Featured with high success rate but short time consumption,lightwand can be used for routine tracheal intubation and predictionof difficult tracheal intubation in infection operations for its slight influence to hemodynamics and few complications arised.The distance of contiguous respiratory tract of medic and patient were raised.