盲探气管插管装置在口腔颌面骨折手术麻醉经鼻气管插管的意义

Application significance of blind tracheal intubation instrument in the nasotracheal intubation anesthesia for oral maxillofacial fractures

目的探讨盲探气管插管装置（BTII）在口腔颌面骨折手术麻醉经鼻气管插管的意义。方法选择全身麻醉下行颌面骨折切开复位内固定术患者90例,ASAⅠ-Ⅱ级,患者分为3组,均采用清醒经鼻气管插管,并由专人操作：Ⅰ组为传统盲探组,即根据呼吸的气流声音经鼻气管插管;Ⅱ组为纤维支气管镜（简称纤支镜）引导组,即先把纤支镜插入气管后再由其引导插入气管导管;Ⅲ组为BTII引导插管组,即通过光导把盲探气管插管装置的导管插入气管后再引导插入气管导管。分别记录麻醉插管前、气管插管即刻和插管后5 min的心率（HR）、收缩压（SBP）、舒张压（DBP）、脉搏氧饱和度（SpO2）,一次气管插管成功率、气管插管失败率、插管时间和并发症等情况。结果 （1）3组插管即刻的HR、SBP和DBP均较插管前和插管后5min升高,差异有统计学意义（P〈0.05）;3组各时间点SpO2比较差异无统计学意义（P〉0.05）。（2）Ⅰ组一次气管插管成功率为50.0%,Ⅱ组为96.7%,Ⅲ组为93.3%,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义（P〈0.05）,Ⅲ组与Ⅱ组比较,差异无统计学意义（P〉0.05）。（3）Ⅰ组气管插管失败率为26.7%,Ⅱ组为0.0%,Ⅲ组为3.3%,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义（P〈0.05）,Ⅲ组与Ⅱ组比较,差异无统计学意义（P〉0.05）。（4）Ⅰ组气管插管时间为（94.1±14.0）s,Ⅱ组为（64.6±7.8）s,Ⅲ组为（65.3±9.1）s,Ⅱ组、Ⅲ组与Ⅰ组比较,差异均有统计学意义（P〈0.05）,Ⅲ组与Ⅱ组比较,差异无统计学意义（P〉0.05）。（5）3组经鼻气管插管后并发症情况：Ⅰ组鼻咽部出血12例,Ⅱ组2例,Ⅲ组4例;Ⅰ组术后咽喉痛8例,Ⅱ组1例,Ⅲ组2例。结论 BTII在口腔颌面骨折手术麻醉经鼻引导气管插管安全、简单、可靠,值得临床推广和应用。

Objective To investigate the application significance of blind tracheal intubation instrument（BTII）in the nasotracheal intubation anesthesia for oral maxillofacial fractures.Methods 90 cases of patients treated with open reduction and internal fixation for maxillofacial fractures after general anaesthesia and American Society of Anethesiology（ASA）Ⅰ-Ⅱ were selected and divided into 3groups.All of the patients were treated with awake nasal intubation operated by professional persons.Group Ⅰ received traditional blind transnasal tracheal intubation,according to the air sound of breath.Group Ⅱ received endotracheal intubation under fiberoptic bronchoscope through nose.GroupⅢreceived endotracheal intubation under BTII.HRs,SBPs and DBPs before intubation（T0）,at the intubation（T1）and 5min after intubation（T2）were recorded,and the one-time successful rates of intubation,the failure rates,the spent-time of successful intubation and the complications of 3groups were also recorded.Results（1）The HR,SBP and DBP of 3groups at T1 were significantly higher than those at T0 and T2（P〈0.05）.There was no significant difference of SpO2 at each time point among 3groups（P〉0.05）.（2）The one-time successful rates of intubation of group Ⅰ,Ⅱ and Ⅲ were 50.0%,96.7% and 93.3% respectively,which of group Ⅰ was significantly different from group Ⅱ and Ⅲ（P〈0.05）,and there was no significant difference between group Ⅱ and Ⅲ（P〉0.05）.（3）The failure rates of groupⅠ,Ⅱ and Ⅲ were 26.7%,0.0%and 3.3%respectively,which of groupⅠ was significantly different from groupⅡ and Ⅲ（P〈0.05）,and there was no significant difference between groupⅡandⅢ（P〉0.05）.（4）The spent-time of successful intubation of group Ⅰ,Ⅱ and Ⅲ were（94.1±14.0）,（64.6±7.8）and（65.3±9.1）s respectively,which of group Ⅰ was significantly different from group Ⅱ and Ⅲ（P〉0.05）,and there was no significant difference between group Ⅱ and Ⅲ（P〉0.05）.（5）The complications occurred in 3groups after intubation.There were 12,2and 4cases with nasopharyngeal hemorrhage and 8,1and 3cases with sore throat respectively in group Ⅰ,Ⅱ and Ⅲ.Conclusion It is safety,simple and reliable to use BTII in the nasotracheal intubation anesthesia for oral maxillofacial fractures,which is worthy to be promoted and applied in clinical.