手术室外困难气道患者清醒插管方式的比较

Comparison of Awake Intubation Methods for Difficult Airway Patients Outside the Operating Room

目的比较在手术室外困难气道患者清醒气管插管时,使用可视喉镜与使用纤维支气管镜的差异。方法选择我院2017年4月—2018年4月手术室外需行气管插管的困难气道患者48例,随机分为可视喉镜组(VL组)和纤维支气管镜组(FOB组),每组各24例。充分表麻后,VL组行可视喉镜引导下清醒气管插管,FOB组行纤维支气管镜引导下清醒气管插管。观察两组患者插管时间、一次插管成功率、插管失败率、呛咳及口咽部出血情况,并用视觉模拟评分来评估患者插管不适程度。结果两组平均插管时间VL组明显短于FOB组(P<0.01)。一次插管成功率、插管失败率、呛咳发生率、口咽部出血发生率、插管不适的视觉模拟评分的比较,差异均无统计学意义(P>0.05)。结论可视喉镜与纤维支气管镜用于手术室外困难气道患者的清醒插管均安全、可行,但可视喉镜操作用时较短,应对危急情况更有优势。

Objective To compare the difference of using visual laryngoscope and fiberoptic bronchoscopy in awake intubation in patients with difficult airways outside the operating room.Methods 48 patients with difficult airways who were planing to receive tracheal intubation outside the operating room from April 2017 to April 2018 in the hospital were randomly divided into visual VL group and FOB group,24 cases in each group.After fully surface anesthesia,visual laryngoscopy-guided awake tracheal intubation was performed in the VL group and fiberoptic bronchoscopy-guided awake tracheal intubation was performed in the FOB group.The intubation time,the success rate of the initial intubation,the failure rate of intubation,bucking and oropharyngeal hemorrhage were observed in the two groups,and intubation discomfort was assessed with a visual analogue scale.Results The mean intubation time in the VL group was significantly shorter than that in the FOB group(P<0.01).There was no statistically significant differences between the two groups in the success rate of the initial intubation,the failure rate of intubation,visual analogue scores of intubation discomfort,bucking incidence and oropharyngeal bleeding incidence(P>0.05).Conclusion Visual laryngoscope and fiberoptic bronchoscope are safe and feasible for the awake intubation of patients with difficult airways outside the operating room.However,the video laryngoscope has a shorter intubation time and has more advantages in responding to critical situations.