纤维支气管镜引导下经鼻清醒气管插管对阻塞性睡眠呼吸暂停综合征患者插管应激反应的影响

Effect of application fiberoptic bronchoscope on the stress reaction caused by nasotracheal intubation in patients with obstructive sleep apnea syndrome

目的评价纤维支气管镜(FOB)引导下经鼻清醒气管插管对阻塞性睡眠呼吸暂停综合征(OSAS)患者插管应激反应的影响。方法择期全麻下行悬雍垂腭咽成形术的OSAS患者60例,ASAⅡ或Ⅲ级,年龄41～65岁,MallampatisⅢ或Ⅳ级。随机均分为两组:A组,经鼻盲探气管插管;B组,经FOB引导经鼻气管插管。记录麻醉前(T0)、插管成功即刻(T1)、插管后1min(T2)、3min(T3)的MAP、HR、SpO2及ECG变化,并于各时点取桡动脉血5ml检测血浆中肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)的浓度;记录两组插管时间、插管成功率和插管期间高血压、心动过速、心肌缺血及损伤性鼻出血的发生情况。结果与T0时比较,T1、T2时两组的MAP、血浆E、NE和Cor浓度明显升高、HR明显增快(P<0.05)。与A组比较,T1～T3时B组MAP、血浆E、NE和Cor的浓度明显降低(P<0.05),T1、T2时HR明显减慢(P<0.05)。B组气管插管时间(45±9)min明显短于A组(54±13)min。B组气管插管成功30例(100%)明显高于A组26例(86.7%)(P<0.05)。B组心动过速0例(0%)、高血压7例(23%)及心肌缺血6例(20%),明显低于A组的13例(43%)、16例(52%)、13例(43%)(P<0.05)。结论 FOB引导下经鼻气管插管可明显减轻OSAS患者插管应激反应,维持血流动力学稳定,提高插管成功率,减少并发症。

Objective To investigate the effects of nasotracheal intubation assisted by fiberoptic bronchoscope on the stress reaction in patients with obstructive sleep apnea syndrome （OSAS）. Methods Sixty ASA Ⅱ or Ⅲ, MallampatiⅢor Ⅳ patients, with OSAS,aged 41-65 years,scheduled for uvulopalatopharyngoplasty, were randomly divided into 2 groups （n= 30 each） ： group A, blind nasotracheal intubation and group B, nasotracheal intubation assisted FOB. MAP, HR, SpO2 and change situation of ECG were recorded at before induction（T0 ）, immediately after the intubation（T1 ）, andl （T2）, 3 min（T3 ） after intubation; and the blood sample were obtained for measuring the plasma concentration of Cor, E, NE at each time point and intubation time, rate of successful intubation, nasal bleeding, and incidences of complications during intubation such as hypertension, tachycardia and myocardial ischemia were recorded. Results Compared with To, MAP and HR at T1, T2 in both groups, and MAP at Ts in group A were increased, the plasma concentrations of E, NE and Cor at T1 ,T2 in both groups and the plasma concentrations of E, NE and Cor at Ts in group A were increased（P〈0. 05）. Compared with group A, MAP, HR at T1 ,T2 and MAP at Ts in group B were decreased, the plasma concentrations of E, NE and Cor in group B at T1, T2 ,Ts were decreased（P〈0.05）. The intubation time was shorten, the rate of successful intubation was higher, incidences of hypertension, tachycardia and myocardial ischemia were lower, and the number of nasal bleeding during intuhation was lower in group B. Conclusion Nasotracheal intubation assisted by FOB can inhibit the stress reaction in patients with OSAS.