输尿管软镜与纤维支气管镜经鼻困难气管插管的比较

Comparison of difficult nasotracheal intubation with flexible ureteroscope and fiberoptic bronchoscope

目的比较输尿管软镜与纤维支气管镜经鼻困难气管插管的临床效果。方法 60例困难气管插管患者,随机均分为两组,分别采用输尿管软镜（FU组）和纤维支气管镜（FOB组）引导经鼻气管插管。记录麻醉诱导前（T1）、插管前（T2）、插管后即刻（T3）、插管后5 min（T4）的MAP、HR、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%及心律失常等）;术后随访患者口咽及气道等插管相关损伤情况。结果与T2比较,T3时两组患者HR增快、MAP增高、SPO2降低（P〈0.05）,两组间差异无显著性（P〉0.05）;FU组和FOB组插管一次成功率分别为90.0%和93.3%、插管时间分别为（180±90）和（156±66）s,两组间差异无显著性（P〉0.05）;插管过程中两组患者Sp O2均维持在91%100%,均未出现激烈呛咳、喉痉挛、躁动及呼吸抑制等并发症,术后随访两组各有1例患者轻微咽喉痛,两组均无声嘶和插管相关损伤。结论与纤维支气管镜相比较,输尿管软镜引导经鼻困难气管插管同样有效可行,值得在基层医院临床工作中应用。

[ Objective ] To compare the effects of difficult nasotraeheal intubation with flexible ureteroscope and fiberoptie bronehoseope. [Methods] Sixty eases of patients with difficult tracheal intubation were randomly divided into two groups, nasotracheal intubation was respectively performed with flexible ureteroscope （n =30, group FU） and fiberoptie bronchoseopy （n =30, group FOB）. MAP, HR and SPO2 were recorded at 4 time points： before induction of anesthesia （T1）, just before intubation （T2）, just after intubation （Y3） and 5 minutes after intubation （T4）; The success rate of intubation, intubation time （since the intuhation operation to succeed） and the complications （cough, laryngeal spasm, agitation, respiratory depression, SPO2〈90%, arrhythmia, etc.） were observed; Postoperative follow-up of patients were recorded with oropharyngeal and airway intubation injury. [ Results ] Compared to T2, the HR and the MAP were increased, and the SPO2 was decreased at T3 in both groups （P 〈0.05）, hut there were not significant differences between two groups （P 〉0.05）; The one-time success rate of intubation in group FU and group FOB were respectively 90.0% and 93.3%, and the intubation time were respectively （180±90） s and （156±66） s in group FU and group FOB, the differences were not statistically significant between two groups （P〉0.05）. SPO2 in the intubation process in both groups was maintained at 91 -100%, there were no complications such as fierce cough, laryngeal spasm, agitation and respiratory depression. There was 1 case of minor sore throat in patients postoperative follow-up in each group, and no hoarseness and injury related catheter in both groups. [Conclusion] Compared with the fiberoptic bronehoseopy, difficult nasotracheal intubation guided by flexible ureteroseopy also is feasible and effeeltive, this method could be widely used in basic hospital.