改良鼻咽通气管联合插管软镜行气管插管的临床研究

Clinical research on the modified nasopharyngeal airway tube combined with intubation soft lens in endotracheal intubation

目的观察改良鼻咽通气管联合插管软镜行气管插管的临床效果。方法选择2013年5月至2015年5月200例择期行扁桃体切除声带息肉摘除患者,年龄18~60岁。经患者知情同意,并签署知情同意书后,将患者分为A、B、C、D组,每组50例。A、B两组由高年资麻醉医生(获得执业医师证工作满5年以上)进行气管插管,C、D两组由低年资(获得执业医师证工作5年以下)麻醉医生插管。A、C两组患者麻醉诱导后先经一侧鼻腔置入鼻咽通气管,然后使用插管软镜经鼻咽通气管进行气管插管,B、D两组麻醉诱导后直接使用插管软镜经鼻腔插管。分别记录各组插管时间、插管次数、首次暴露声门时间、失败例数及插管不良反应或并发症。结果插管所用时间A组短于B组、C组短于D组,差异均有统计学意义(P<0.05)。A、C组一次插管成功率分别为84%、82%,失败率均为2%,B、D组一次插管成功率分别为50%、30%,失败率分别为10%、20%,A组与B组比较、C组与D组比较、B组与D组比较差异均有统计学意义(P<0.05)。结论改良鼻咽通气管联合插管软镜可以明显缩短插管时间,提高插管成功率,联合使用时高年资与低年资麻醉医生插管时间及失败率均无明显差异。

Objective To observe clinical effects of the modified nasopharyngeal airway tube combined with intubation softlens in endotracheal intubation. Methods Two hundred patients who were to receive surgery were chosen as research subjects. With the knowledge and consent of the patients and following the signing of the letter of agreement, the patients were divided into 4 groups： group A , B, C and D, each consisting of 50 patients. For the patients of group A and B, endotracheal intubation was performed by high-qualified anesthesiologists （with the certificate of medical practitioner for over 5 years） , while for the patients of group C and D, intubation was done by low-qualified ones （with the certificate of medical practitioner for less than 5 years） . For the patients of group A and C , nasopharyngeal airway tube was placed through the approach of side nasal cavity following anesthesia induction, and then soft lens was used to complete endotracheal intubation via nasopharyngeal airway. For the patients of group B and D, soft lens intubation was performed directly through nasal cavity following anesthesia induction. Medical data, such as intubation time, number of intubation, first time of glottis exposure, cases of intubation failure, and adverse reactions or complications induced by intubation were recorded for further analysis. Results The intubation time of group A was shorter than that of group B, and the time of group C was shorter than that of group D, and statistical significance could be seen, when comparisons were made between them（P 〈0.05）. The success rate at the first try of intubation for group A and C were respectively 8 4 % and 8 2 % , and the failure rate was all 2 % , while for group B and D the success rate of intubation were respectively 5 0 % and 3 0 % , and failure rates were respectively 10% and 20%. Statistical significance could be noticed, when comparisons were made between the groups, i. e. between group A and B, between group C and D and also be-tween group B and D（ P 〈0. 05） . Conclusion Modified nasopharyngeal airway tube combined with intubation soft lens could obviously shorten endotracheal intubation time and increase the success rate of intubation. No significant differences could be noted in intubation time and failure rate, when the use of modified nasopharyngeal ainvay tube was combined with intubation soft lens by high-qualified and low-qualified anesthesiologists.