旋转盲探插管在困难气管插管中的应用

The application of revolving and blind intubation in difficult endotracheal intubation

目的探讨行快速诱导经口旋转盲探气管内插管法在困难气管插管的可行性。方法选择我院2009年6月～2011年3月美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级、择期气管插管全麻、麻醉前预测为困难气管插管患者60例,根据Cormack-Lehane分级分为两组,Cormack-Lehane分级Ⅲ级和Ⅳ级为困难气管作为盲探组（25例）,采用旋转盲探插管法;Cormack-Lehane分级Ⅰ级和Ⅱ级作为明视组（35例）,采用Macintosh喉镜常规插管法。记录患者麻醉诱导前、麻醉诱导后、气管插管即刻及气管插管后5 min各时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SpO2）,及插管成功率、插管时间、插管后咽喉并发症等情况。结果与明视组比较,盲探组在气管插管总时间、1次成功率方面,差异有统计学意义（P〈0.05）,两组插管成功率均为100.0%;与麻醉诱导前比较,两组麻醉诱导后和插管后5 min的SBP、DBP均显著降低,差异均有统计学意义（均P〈0.05）,气管插管即刻SBP、DBP无显著性变化,差异无统计学意义（P〉0.05）,而HR显著升高,差异有统计学意义（P〈0.05）。与麻醉诱导后比较,气管插管即刻的SBP、DBP和HR均显著升高,差异均有统计学意义（均P〈0.05）。SpO2在各时间点差异无统计学意义（P〉0.05）。两组患者均无严重的咽喉并发症。结论快速诱导经口盲探气管内插管法用于困难气管插管,操作简单易行,成功率高,并发症少,值得临床推广。

Objective To investigate the safety and effectiveness of revolving and blind intubation in difficult endotracheal intubation.Methods 60 patients in ASA Ⅰ-Ⅱ grade who were predicted with difficult tracheal intubation under elective general anesthesia were enrolled in this study.Based on the results of Cormack-Lehane classification,all the patients were classified into blind group（including 25 patients with Cormack-Lehane′s grade Ⅲ or Ⅳ） and vision group（containing 35 patients with Cormack-Lehane′s grade Ⅰ or Ⅱ）.Revolving and blind intubation was performed in blind group,and direct vision orotracheal intubation with Macintosh laryngoscope was used in vision group.The SBP,DBP,HR and SpO2 in the two groups in the time of before anesthesia induction,after anesthesia induction,trachea cannula and 5 min after trachea cannula were recorded,the success ratio,the time and the relative complications of trachea cannula were observed and recorded in all patients.Results The differences of total time of trachea cannula,success ratio of 1 time in two groups were all statistically significant（all P 0.05）,the successful rate of trachea cannula was 100.0%;SBP and DBP of the two groups in the time of after anesthesia induction and 5 min after trachea cannula were lower than those of before anesthesia induction,the differences were all statistically significant（all P 0.05）,SBP and DBP in the time of trachea cannula were found no changes,the differences were not statistically significant（P 0.05）,the HR was found higher,the difference was statistically significant（P 0.05）.SBP,DBP and HR of the two groups in the time of trachea cannula were found higher than those in the time of after anesthesia induction,the differences were all statistically significant（all P 0.05）.The levels of SpO2 were found no differences in all the points of times,the differences were not statistically significant（P 0.05）.No serious throat complications were found in the two groups.Conclusion Revolving and blind tracheal intubation for difficult tracheal intubation has high successful rate and few relative complications and may be valuable for clinical anesthesia work.