ETView可视气管导管应用于麻醉气道管理临床分析

Clinical analysis of ETView visual endotracheal tube for anesthetic airway management

目的探讨ETView可视气管导管(ETView tracheoscopic ventilation tube,ETView TVT)在麻醉使用中的临床特点,为ETView TVT在气道管理中的合理应用提供依据。方法收集本院临床麻醉气道管理中ETView TVT应用的56例病例,分析其患者气道特点、临床应用经过以及患者插管后的效果。结果 56例患者中术前计划使用ETView TVT患者32例,非计划使用24例。心脏手术患者30例,其中术中联合支气管封堵器行单肺通气患者8例,术后长期带管机械通气并需要吸痰者14例,未预料困难气管插管8例;胸科手术术中双腔气管插管行单肺通气失败转而ETView TVT联合支气管封堵器患者10例;耳鼻喉科手术术中需要气管切开患者10例;其他手术未预料困难气管插管6例。56例患者Macintosh直接喉镜下暴露Cormack和Lehane分级Ⅰ级1例,Ⅱ级16例,Ⅲ级25例,Ⅳ14例,而ETView TVT暴露均为Ⅰ级,2种方法的Cormack和Lehane分级差异有统计学意义(P<0.01)。56例患者使用ETView可视气管导管插管过程中血氧饱和度(SpO_2)均≥95%,通气顺利,术后无插管相关并发症。结论 ETView可视气管导管可简化气道管理流程,改善咽喉部结构暴露,安全用于未预料困难气道患者,有助于术后长期带管吸痰,避免更换气道工具中出现低氧血症,减低围术期气道风险。

Objective To evaluate the usefulness of ETView TVT for anesthetic airway management by analyzing the clinical characteristics of 56 cases. Method We collected 56 cases of ETView TVT for anesthetic airway management in our hospital. The patients＇ airway characteristics, the clinical manifestations and outcomes were recorded and analyzed. Result 32 cases of ETView TVT were used according to plan, while 24 cases were unplanned. Among 56 cases, 30 cases of ETView TVT were in cardiac anesthesia, including 8 cases for one lung ventilation with the endobronchial blocker tube, 14 cases for postoperative long-term mechanical ventilation and bronchial aspiration, 8 cases for unpredicted difficult intubation. 10 cases were for alternative one lung ventilation with the endobronchial blocker tube after double-lumen tube ventilation failed in thoracic surgery. 10 cases were for tracheotomy in otolaryngological surgery. 6 cases were for unpredicted difficult airway management in other types of surgeries.All 56 patients had Cormack and Lehane glottis view level I by ETView TVT, while 1 patient had level I , 16patients had level II, 25 patients had level III, 14 patients had level IV by Macintosh. Patients had a better Cormack and Lehane glottis view by ETView than by Macintosh （P〈0.01）. All the patients maintained SpO2-95% during intubation and the airway management was resolved with ETView TVT without advert complications associated with intubation. Conclusion Useness of ETView TVT simplies the airway management protocol, improves the Cormack and Lehane glottis view, facilitates unpredicted difficult airway management and postoperative bronchial aspiration, avoids hypoxemia during replacing airway equipments and decreases airway risk.