侧卧位光棒引导气管插管的临床研究

A clinical study of lightwand-guided intubation of patients in the lateral position

目的探讨侧卧位光棒引导气管插管的可行性和安全性。方法选取2014-10/2015-09福建医科大学附属协和医院需侧卧位择期泌尿外科手术的75例住院患者,随机分为3组,平卧位喉镜组、平卧位光棒组、侧卧位光棒组。两组平卧位组是患者平卧位分别使用Macintosh直接喉镜和光棒引导插管后摆侧卧位手术,侧卧位光棒组则在摆好侧卧位后使用光棒引导气管插管,比较各组插管期间血流动力学变化、插管时间、插管成功率和插管并发症。结果各组插管后均有血压和心率的升高。平卧位喉镜组、平卧位光棒组、侧卧位光棒组的插管时间分别是(22.3±9.5)s、(18.1±10.32)s、(17.6±13.1)s。平卧位喉镜组1次插管成功22例(88%),有3例误入食道(12%),第2次插管成功;平卧位光棒组25例(100%)均1次插管成功,侧卧位光棒组1次插管成功22例(88%),1例(4%)误入食道,第2次插管成功,2例(8%)在喉镜辅助下第3次插管成功。各组术后插管并发症均少。结论侧卧位光棒引导气管插管是安全可行的。

Objective To evaluate the feasibility and safety of lightwand-guided intubation of patients in the lateral position. Methods From October 2014 to September 2015,75 inpatients,who needed elective urinary surgery of lateral position in Union Hospital of the Fujian Medical University,were randomly assigned to three groups: supine laryngoscopy group,supine lightwand group and lateral lightwand group. In the two supine groups,Macintosh direct laryngoscopy and lightwand-guided intubation were respectively performed in the supine position and then in the lateral position. In lateral lightwand group,lightwand-guided intubation was performed in the lateral position. Finally,data were collected in the three groups,including the hemodynamic changes during intubation,intubation time,success rate and complications of intubation. Results Blood pressure and heart rates were increased after intubation in each group. The intubation time was( 22. 3 ± 9. 5) s in supine laryngoscopy group,( 18. 1 ± 10. 32) s in supine lightwand group and( 17. 6 ± 13. 1) s in lateral lightwand group. In supine laryngoscopy group,the success rate of the successful first-attempt intubation was 88%( 22 cases),and the success rate of the successful second-attempt intubation was 12%( 3 cases) due to the intubation into esophagus by accident. in the supine lightwand group,the success rate of the successful first-attempt intubation was 100%( 25 cases). In lateral lightwand group,that was 88%( 22 cases),and the success rate of the successful second-attempt intubation was 4%( 1 case) due to the intubation into esophagus by accident,and the success rate of the successful third-attempt intubation was 8%( 2 cases) combined with laryngoscope and lightwand. Postoperative complications related to intubation were fewer in all groups. Conclusion Lateral lightwand-guided tracheal intubation is feasible and safe.