软质激光气管插管引光器用于口腔颌面部手术经鼻插管42例

Flexible laser endotracheal intubation optical device used for oral and maxillofacial intubation operations in 42 patients

目的探讨软质激光气管插管引光器(专利号201520785723.7)在口腔颌面部手术麻醉经鼻插管中的应用效果。方法口腔颌面手术经鼻插管全麻患者42例,年龄16~73岁,美国麻醉医师协会(ASA)Ⅰ~Ⅱ。常规气道和鼻腔表面麻醉准备,27例张口度<3 cm患者,采用引光器联合导管管芯清醒经鼻光引导插管:静脉滴注咪达唑仑0.05 mg/kg,舒芬太尼0.2μg/kg药物后,将加强型气管导管插入13~15 cm咽喉部,再将先前已塑形为120°弧度的导管管芯和引光器先后置入导管内,通过颈前光斑引导插管。15例张口度≥3 cm患者,采用快诱导经鼻光引导并直接喉镜辅助插管:静脉滴注咪达唑仑0.05 mg/kg、舒芬太尼0.5μg/kg、丙泊酚2 mg/kg、顺苯0.2 mg/kg诱导药物后,将连接好引光器的加强型气管导管从鼻孔置入口咽部,在置入喉镜挑起会厌下完成引导插管操作。记录插管成功率、插管时间、插管前和插管后即刻平均动脉压、心率及相关并发症的发生情况。结果 42例患者中,41例引导插管成功,插管成功率97.6%;插管时间12~276 s,平均插管时间(124.5±38.2)s;操作时平均动脉压、心率升高幅度均在正常范围内(<30%),血氧饱和度(SpO_2)维持在0.92~1.00,无躁动;术后无声嘶、咽痛等严重并发症发生。结论软质激光气管插管引光器(光棒)可快速应用于口腔颌面部手术经鼻引导插管,引光器传出端45°斜面设计可形成向前和向上方向2束高亮度强光区,更加方便光引导定位,成功率高,刺激小,为经鼻插管提供了一种新工具。

Objective To explore the effect of flexible laser endotracheal intubation optical device (patent number 201520785723.7) on oral and maxillofacial intubation operations. Methods Forty- two patients with the oral and maxillofacial intubation optical device for general anesthesia were included in this study. The patients were from 16 to 73 years old and ASAⅠ-Ⅱ. Surface anesthesia was prepared for airway and nasal cavity. There were 27 patients whose mouth opening were smaller than 3 cm. After intravenous injection of midazolam 0.05 mg/kg and sufentanil 0.2 μg/kg, reinforced endotracheal tube was inserted into throat 13-15 cm, then the probe shape to 120° and optical device were placed into the tube respectively, guided the tube according to the light spot in front of neck. There were 15 patients whose mouth opening were not smaller than 3 cm. The quick guidance optical device and larygoscope were adopted to help the intubation. After intravenous injection of midazolam 0.05 mg/kg, sufentanil 0.5 μg/kg, propofol 2 mg/kg, cisatracurium 0.2 mg/kg, the reinforced endotracheal tube was inserted into the oral cavity nasally, and completed intubation with laryngoscope. The success rate of intubation, time of intubation, the real-time blood pressure before and after intubation, heart rate and related complications were recorded before intubation and after intubation. Results In the 42 patients, 41 patients were successful for guidance intubation, and the success rate of intubation was about 97.6%. The average intubation time was(124.5±38.2)seconds. The shortest intubation time was 12 seconds and the longest was 276 seconds. During intubation, the increases of blood pressure and heart rate were in the normal range (<30%). Levels of SpO2 were maintained at 0.92-1.00. All the patients were without agitation. There were no serious complications such as hoarseness and pharyngalgia after operation.Conclusion The flexible laser endotracheal intubation optical device can be used quickly for oral and maxillofacial intubation, and the 45° bevel design for optical device can form two kinds of zones with bright light upward and downward. It is a new tool for nasal intubation that is more convenient for location of light guidance, and has high success rate and small stimulation.