T型接头内镜面罩用于颈髓损伤患者纤维支气管镜引导清醒气管插管术的效果

Efficacy of T-joint endoscopy mask for fiberoptic bronchoscopy.guided awake nasotracheal intubation in patients with cervical spinal cord injury

目的评价T型接头内镜面罩用于颈髓损伤患者纤维支气管镜（FOB）引导清醒气管插管术的效果。方法颈椎骨折并发颈髓损伤患者40例，拟在经鼻气管插管全身麻醉下行颈前路脊髓减压植骨内固定术，性别不限，年龄21-64岁，采用随机数字表法，将患者随机分为2组（n=20）：鼻导管组和内镜面罩组。以2％利多卡因行舌根部和咽喉表面麻醉，然后行环甲膜穿刺，注射_2％利多卡因2ml，静脉输注瑞芬太尼0．05～0．15μg·kg-1·min-1。记录气管插管期间低氧血症的发生情况。分别于表面麻醉前（基础状态）、置人FOB前即刻、置入FOB后1min和气管插管后即刻时采集动脉血样，测定PaO2和PaCO2。结果鼻导管组和内镜面罩组低氧血症的发生率分别为25％和0；与鼻导管组比较，内镜面罩组低氧血症发生率降低，PaO2升高（P〈0．05），PaCO2和气管插管时间差异无统计学意义（P〉0．05）。结论对于颈髓损伤患者FOB引导清醒气管插管术，应用T型接头内镜面罩不仅可提供便利的操作条件，而且还不影响吸氧。

Objective To evaluate the efficacy of T-joint endoscopy mask for fiberoptic bronchoscopy （FOB）-guided awake nasotraeheal intubation in patients with cervical spinal cord injury. Methods Forty patients of both sexes aged 21-64 yr with fracture of cervical spine complicated by spinal cord injury scheduled for anterior decompression and interbody fusion under general anesthesia were randomly divided into 2 groups according to the technique for awake nasotracheal intubation （ n = 20 each） ： group nasal catheter and group T-joint endoscopy mask. Topical anesthesia of nasal cavity, pharynx, larynx and trachea with 2 % lidocaine was conducted and then remifentanil was continuously infused at 0.05-0.15 ~g＂ kg-1 ~ min-1 in both groups. The incidence of hypoxemia and intubation time were recorded. Arterial blood samples were obtained for determination of PaO2 and PaCO2 be- fore topical anesthesia （baseline）, immediately before and 1 min after placement of FOB and immediately after na- sotracheal intubation was accomplished. Results The incidence of hypoxemia was significantly lower in group T- joint endoscopy mask （0） than in group nasal catheter （25 % ）（ P 〈 0.05 ）. The PaO2 during nasotracheal intuba- tion was significantly higher in group T-joint endoscopy mask than in group nasal catheter （P 〈 0.05）. There was no significant difference in PaCO2 and intubation time between the 2 groups （ P 〉 0.05）. Conclusion T-joint en- doscopy mask facilitates awake nasotracheal intubation without affecting oxygen inhalation in patients with cervical spinal cord injuries.