输尿管软镜引导经鼻困难气管插管的临床应用

Clinical application of transnasal tracheal intubation with difficult airway guided by flexible ureteroscope

目的观察输尿管软镜引导经鼻困难气管插管的临床效果。方法42例困难气管插管患者采用输尿管软镜引导经鼻气管插管。记录患者麻醉诱导前、插管前、插管后即刻、插管后5min的MAP、FIR、SpO2；记录插管成功率、插管时间（自插管操作至成功）、并发症情况（呛咳、喉痉挛、躁动、呼吸抑制、SpO2〈90％、心律失常等）；术后随访患者口咽及气道等插管相关损伤情况。结果插管一次成功率为90．5％，二次成功率为100％，完成插管时间1-8min，平均4．2min。插管过程中SpO2维持在91％～100％，血流动力学维持在正常范围，未出现激烈呛咳、喉痉挛、躁动、呼吸抑制等并发症，术后随访无声嘶、明显咽部不适和插管相关损伤。结论输尿管软镜引导经鼻困难气管插管安全可行，简捷有效，值得在基层医院临床工作中应用。

Objective To observe the clinical effcct of transnasal tracheal intubation with difficult airway guided by flexible urctcroscope. Methods Transnasal trachcal intubation was pcrforrncd with flexible urcteroscope in 42 patients with difficult airway. Mean arterial pressure （MAP）, heart rate （HR） and SpO2 wcrc recorded at 4 time points： before induction of anesthesia, just bcfote intubation, just after intubation and 5 minutes aRer intubation. The success rate of intubation, intubation timc （since thc intubation opcration to succccd） and the complications （cough, laryngeal spasm, agitation, respiratory depression, SPO2〈90%, arrhythmia, ctc.） wcre obscrvcd. Postoperative follow-up of patients wcrc recorded with oropharyngcal and airway intubation injury. Results Thc one-time succcss rate of intubation was 90.5%, and the two-time success rate was I00%. The intubation tirnc was I-8 minutes and the average time of intubation was about 4.2 minutes. SpO2 in the intubation process was maintained at 91%-I00%, hcmodynamics remained in thc normal range. Thcre wcre no complications such as fierce cough, laryngeal spasm, agitation and respiratory depression. Postoperative follow-up of patients wcrc found with no hoarscncss, obvious pharyngeal discom- fort and cathcter related injury. Conclusion Transnasal tracheal intubation with difficult airway guided by flexible uretcroscope is safe and feasible, simple and cffcctivc, which could bc widely uscd in basic hospitals.