管芯钝头引导气管插管在意外困难气道中的应用

Application of Tracheal Intubation Guided by Blunt Cable End in Unexpected Difficult Airway

目的观察管芯钝头引导气管插管在意外困难气道中的应用效果。方法选择2012年10月至2014年12月襄阳市中心医院麻醉科收治的意外困难气道患者48例,依据随机数字表法分为观察组和对照组,各24例。对照组气管导管前端采用普通管芯塑形成传统鱼钩状（J形）;观察组管芯前端3 cm处折叠成钝头,充分润滑后伸出导管斜口1-2 cm,塑形成小鱼钩状。记录两组患者插管成功例数、插管所用时间以及监测记录诱导前（T0）、诱导后（T1）和插管成功后即刻（T2）3个时点的收缩压、舒张压和心率以及术后呼吸道损伤并发症（如损伤出血、咽喉疼痛、声音嘶哑）。结果观察组插管一次成功率高于对照组[87.5%（21/24）比58.3%（14/24）],普通喉镜插管用时短于对照组[（19±5）s比（31±7）s],差异均有统计学意义（P〈0.05）。两组患者收缩压、舒张压和心率在T1显著降低,又在T2显著上升,两组不同时点间间比较差异有统计学意义（P〈0.05）。对照组呼吸道损伤发生率为16.7%（4/24）,观察组为8.3%（2/24）,两组呼吸道损伤发生率比较差异无统计学意义（P〉0.05）。结论管芯钝头引导气管插管能明显提高意外困难气道插管成功率并缩短插管时间,且无不良心血管反应和明显呼吸道损伤并发症。

Objective To observe the application effect of tracheal intubation guided by blunt cable end in unexpected difficult airway. Methods Forty-eight patients with unexpected difficult airway admitted to Xiangyang Central Hospital from Oct. 2012 to Dec. 2014 were randomly divided into control group and observation group,24 cases in each group. In the control group,the anterior extremity of tracheal catheter was moulded like traditional fish-hook shape（ J shape） with ordinary cable. In the observation group,the tip of cable was folded as blunt end at 3 centimeters and lubricated fully. Meanwhile,the blunt end was exserted through the catheter mouth within 1-2 centimeters and also moulded like small fish-hook shape. Intubation achievement cases and intubation time were recorded. Systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and heart rate（ HR） were tested and recorded before（ T0） and after（ T1） induction and following intubation achievement（ T2）. Postoperative complication of airway injury such as bleeding due to trauma,throat pain and hoarse voice were all recorded. Results The first time success rate of intubation of the observation group was higher than the control group[87. 5%（ 21 /24） vs 58. 3%（ 14 /24） ],the time of common intubation of the observation group was lower than the control group [（ 19 ± 5） s vs（ 31 ± 7） s],the differences were statistically significant（ P〈0. 05）. SBP,DBP and HR of the two groups at T1 decreased,but increased significantly from T2,at different time points had statistically significant difference（ P〈0. 05）. Incidence of respiratory tract injury of the control was 16. 7%（ 4 /24）,of the observation group was 8. 3%（ 2 /24）,there was no statistically significant difference（ P〉0. 05）. Conclusion Tracheal intubation guided by blunt cable end can obviously improve intubation success rate and shorten intubation time in unexpected difficult airway without adverse cardiovascular reaction and obvious airway injury complication.