盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管的效果

Efficacy of nasotracheal intubation using blind tracheal intubation device combined with end-tidal carbon dioxide monitoring technique in patients with difficult airway

目的评价盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管的效果。方法择期经鼻气管插管的口腔颌面外科手术患者60例，性别不限，年龄35～64岁，体重55～75kg，ASA分级Ⅰ或Ⅱ级，张口度〈3cm，颈部后仰度〈30°，Mallampati分级Ⅲ或Ⅳ级，甲颏间距〈6．5cm，预计为困难气道。采用随机数字表法，将患者随机分为2组（n=30）：盲探气管插管装置组（Ⅰ组）和盲探气管插管装置联合呼气末二氧化碳监测（Ⅱ组）。Ⅰ组采用盲探气管插管装置进行气管插管；Ⅱ组采用盲探气管插管装置结合呼气末二氧化碳监测进行气管插管。记录气管插管情况、气管插管时间、气管插管期间（鼻衄、心动过速、高血压和低氧血症）和术后（咽痛和声音嘶哑）不良反应的发生情况。结果2组患者气管插管成功率均为100％。2组均未见心动过速、高血压、低氧血症和声音嘶哑的发生。与Ⅰ组比较，Ⅱ组首次气管插管成功率升高，气管插管时间缩短，鼻衄和咽痛的发生率降低（P〈0．05）。结论盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管时可缩短气管插管时间，提高气管插管成功率，减少不良反应的发生。

Objective To evaluate the efficacy of nasotracheal intubation using blind tracheal intubation device and end-tidal carbon dioxide monitoring technique in patients with difficult airway. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes, aged 35-60 yr,weighing 55-75 kg,requiring nasotracheal intubation, undergoing selective oral and maxillofacial surgery, were involoved in this study. All of them were expected to have difficult airway such as mouth opening 〈 3 cm, neck upward degree 〈 30° and Mallampati classification Ⅲ or Ⅳ. The patients were randomly divided into 2 groups （ n = 30） ： group Ⅰ received tracheal intubation with the blind tracheal intu- bation device and group Ⅱ received tracheal intubation with the blind intubation device combined with end-tidal carbon dioxide monitoring technique. The number of successful intubation, the intubation time and adverse effects during intubation （epistaxis, tachyeardia, hypertension and hypoxemia） and after operation （sore throat and hoarseness） were recorded.Results The rate of successful intuhation in the two groups was 100% . Tachycardia, hypertension, hypoxemia and hoarseness were not found in the two groups. Compared with group I, the rate of successful intubation at first attempt was significantly increased, the intubation time was significantly shortened, and the incidence of epistaxis and sore throat was decreased in group Ⅱ （ P 〈 0.05）. Conclusion The blind intubation device combined with end-tidal carbon dioxide monitoring technique used in difficult airway can shorten the intubation time, increase the success rate of tracheal intubation, and decrease the occurrence of adverse effects.